Provider Demographics
NPI:1598361636
Name:HAJAZ, AMERICO MOTHANA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMERICO
Middle Name:MOTHANA
Last Name:HAJAZ
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 1:3579 W 106TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4623
Mailing Address - Country:US
Mailing Address - Phone:813-205-2006
Mailing Address - Fax:
Practice Address - Street 1:3579 W 106TH TER
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4623
Practice Address - Country:US
Practice Address - Phone:813-205-2006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-04
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN1593207Q00000X
IN01090887A207P00000X, 207P00000X
FL1185208D00000X
NJ037047208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice