Healthcare Provider Details

I. General information

NPI: 1790806370
Provider Name (Legal Business Name): ANTOINE J ELHAJJAR M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46100 WASHINGTON ST
LA QUINTA CA
92253-2042
US

IV. Provider business mailing address

46100 WASHINGTON ST
LA QUINTA CA
92253-2042
US

V. Phone/Fax

Practice location:
  • Phone: 760-340-0528
  • Fax: 760-674-1590
Mailing address:
  • Phone: 760-340-0528
  • Fax: 760-674-1590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberA53481
License Number StateCA

VIII. Authorized Official

Name: DR. ANTOINE JEAN ELHAJJAR
Title or Position: CEO
Credential: M.D.
Phone: 760-340-0528