Provider Demographics
NPI:1467221267
Name:HAJIZADEH, CAMERON BASHY (PA-C)
Entity type:Individual
Prefix:
First Name:CAMERON
Middle Name:BASHY
Last Name:HAJIZADEH
Suffix:
Gender:
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 1:2005 E FARDOWN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-1406
Mailing Address - Country:US
Mailing Address - Phone:801-556-9727
Mailing Address - Fax:
Practice Address - Street 1:3934 S 2300 E
Practice Address - Street 2:
Practice Address - City:SLC
Practice Address - State:UT
Practice Address - Zip Code:84124-2848
Practice Address - Country:US
Practice Address - Phone:801-849-8500
Practice Address - Fax:801-849-8502
Is Sole Proprietor?:No
Enumeration Date:2023-12-21
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13670607-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant