Provider Demographics
NPI:1811585730
Name:HAJAL, OUSSAMA (PA)
Entity Type:Individual
Prefix:
First Name:OUSSAMA
Middle Name:
Last Name:HAJAL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5701 W CHARLESTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-1256
Mailing Address - Country:US
Mailing Address - Phone:702-877-9514
Mailing Address - Fax:702-312-3510
Practice Address - Street 1:5701 W CHARLESTON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1256
Practice Address - Country:US
Practice Address - Phone:702-877-9514
Practice Address - Fax:702-312-3510
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVPA2384363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical