Provider Demographics
NPI:1205805868
Name:HAGER, JAMES T (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:T
Last Name:HAGER
Suffix:
Gender:M
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 1:8067 FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3816
Mailing Address - Country:US
Mailing Address - Phone:562-622-0095
Mailing Address - Fax:562-622-0087
Practice Address - Street 1:11411 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5003
Practice Address - Country:US
Practice Address - Phone:562-622-0095
Practice Address - Fax:562-250-0234
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16622363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P80643Medicare UPIN
CAWPA16622BMedicare ID - Type Unspecified
CAWPA16622AMedicare ID - Type Unspecified