Provider Demographics
NPI:1417353509
Name:FATIMA, HAJERA (DO)
Entity Type:Individual
Prefix:
First Name:HAJERA
Middle Name:
Last Name:FATIMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35380
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-5380
Mailing Address - Country:US
Mailing Address - Phone:702-579-3203
Mailing Address - Fax:
Practice Address - Street 1:600 S DOBSON RD STE D27
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5691
Practice Address - Country:US
Practice Address - Phone:480-496-0000
Practice Address - Fax:480-496-7325
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS13022207Q00000X
AZ008214207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIH725ZMedicare PIN
FLIH725YMedicare PIN
FLIH725XMedicare PIN