Provider Demographics
NPI:1346849007
Name:HAWARA, JANESSA J (PA-C)
Entity type:Individual
Prefix:
First Name:JANESSA
Middle Name:J
Last Name:HAWARA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2243 N NIAGARA ST APT B
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91504-3281
Mailing Address - Country:US
Mailing Address - Phone:818-967-9809
Mailing Address - Fax:
Practice Address - Street 1:5901 W OLYMPIC BLVD STE 505
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4670
Practice Address - Country:US
Practice Address - Phone:323-930-2324
Practice Address - Fax:323-930-2497
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA58619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant