Healthcare Provider Details

I. General information

NPI: 1962452292
Provider Name (Legal Business Name): PAUL HEJJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19636 N 27TH AVE SUITE 106
PHOENIX AZ
85027-4013
US

IV. Provider business mailing address

5281 N 99TH AVE SUITE 100
GLENDALE AZ
85305-3105
US

V. Phone/Fax

Practice location:
  • Phone: 623-516-8252
  • Fax: 623-516-8253
Mailing address:
  • Phone: 623-516-8252
  • Fax: 623-516-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberC51066
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number33476
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberC51066
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number10046
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: