MEDICARE: SHAWNA HAGGENJOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1275983843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA HAGGENJOS

Provider Business Mailing Address
First Line	:	5116 NARRAGANSETT AVE
Second Line	:	33
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-3049
Country	:	US
Telephone Number	:	808-220-0492
Fax Number	:

Provider Business Practice Location Address
First Line	:	5116 NARRAGANSETT AVE
Second Line	:	33
City	:	SAN DIEGO
State	:	CA
Zip	:	92107-3049
Country	:	US
Telephone Number	:	808-220-0492
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2016
Last Update Date	:	06/15/2016

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Directions to “ SHAWNA HAGGENJOS ” Practice Location

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