Healthcare Provider Details

I. General information

NPI: 1164476362
Provider Name (Legal Business Name): ATHIR J HAJJAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ATHIR J MEROGI M.D.

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 10/15/2022
Certification Date: 10/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

671 S MOLLISON AVE SUITE B & C
EL CAJON CA
92020
US

IV. Provider business mailing address

671 S MOLLISON AVE STE B
EL CAJON CA
92020-6618
US

V. Phone/Fax

Practice location:
  • Phone: 619-841-8148
  • Fax: 844-350-9978
Mailing address:
  • Phone: 619-841-8148
  • Fax: 844-350-9978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number036114867
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number036114867
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberCV2200566
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: