=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346849007
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANESSA J HAWARA PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2020
-----------------------------------------------------
Last Update Date | 10/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5901 W OLYMPIC BLVD STE 505
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90036-4670
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-930-2324
-----------------------------------------------------
Fax | 323-930-2497
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2243 N NIAGARA ST APT B
-----------------------------------------------------
City | BURBANK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91504-3281
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-967-9809
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA58619
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------