Provider Demographics
NPI:1356737191
Name:HIJAZI, HUSSEIN (MD)
Entity type:Individual
Prefix:
First Name:HUSSEIN
Middle Name:
Last Name:HIJAZI
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 1:91275 66TH AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MECCA
Mailing Address - State:CA
Mailing Address - Zip Code:92254-6515
Mailing Address - Country:US
Mailing Address - Phone:760-396-1249
Mailing Address - Fax:760-396-1253
Practice Address - Street 1:91275 66TH AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:MECCA
Practice Address - State:CA
Practice Address - Zip Code:92254-6515
Practice Address - Country:US
Practice Address - Phone:760-396-1249
Practice Address - Fax:760-396-1253
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD86132207Q00000X
PAMT212202207Q00000X
CAA169664207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2389891Medicaid