Provider Demographics
NPI:1558328203
Name:ELHAJJAR, ANTOINE JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINE
Middle Name:JEAN
Last Name:ELHAJJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46100 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2042
Mailing Address - Country:US
Mailing Address - Phone:760-340-0528
Mailing Address - Fax:760-674-1590
Practice Address - Street 1:46100 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2042
Practice Address - Country:US
Practice Address - Phone:760-340-0528
Practice Address - Fax:760-674-1590
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53481207RS0012X, 2084N0400X, 174400000X
261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG21302Medicare UPIN
CA00A534811Medicare ID - Type Unspecified