Provider Demographics
NPI:1891126298
Name:AZOUGGAGH, LAILA (PA-C)
Entity Type:Individual
Prefix:
First Name:LAILA
Middle Name:
Last Name:AZOUGGAGH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 MELROSE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4773
Mailing Address - Country:US
Mailing Address - Phone:972-791-8422
Mailing Address - Fax:469-374-3851
Practice Address - Street 1:331 MELROSE DR STE 220
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4773
Practice Address - Country:US
Practice Address - Phone:972-791-8422
Practice Address - Fax:469-374-3851
Is Sole Proprietor?:No
Enumeration Date:2013-12-10
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08719363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical