Healthcare Provider Details

I. General information

NPI: 1346849007
Provider Name (Legal Business Name): JANESSA J HAWARA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2020
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W OLYMPIC BLVD STE 505
LOS ANGELES CA
90036-4670
US

IV. Provider business mailing address

2243 N NIAGARA ST APT B
BURBANK CA
91504-3281
US

V. Phone/Fax

Practice location:
  • Phone: 323-930-2324
  • Fax: 323-930-2497
Mailing address:
  • Phone: 818-967-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58619
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: