Active NPI
Marjan Hafizi, PA-C
- Physician Assistant
- La Jolla, CA
National Provider Identifier
1588914493
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA22339
- Practice address
- 4130 La Jolla Village Dr
Suite 300
La Jolla, CA 92037-9121 - Phone
- (858) 625-7979
- Fax
- (858) 625-2020
- NPI assigned
- Sep 18, 2012
- Last updated
- Sep 18, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA22339 | CA | Primary |
Addresses
Primary practice location
4130 La Jolla Village Dr
Suite 300
La Jolla, CA 92037-9121
Mailing address
4130 La Jolla Village Drive
Suite 300
La Jolla, CA 92037
Phone (858) 625-7979
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1347926400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1347926400000",
"number": "1588914493",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4130 LA JOLLA VILLAGE DRIVE",
"address_2": "SUITE 300",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "92037",
"telephone_number": "858-625-7979",
"fax_number": "858-625-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4130 LA JOLLA VILLAGE DR",
"address_2": "SUITE 300",
"city": "LA JOLLA",
"state": "CA",
"postal_code": "920379121",
"telephone_number": "858-625-7979",
"fax_number": "858-625-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAFIZI",
"first_name": "MARJAN",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-09-18",
"last_updated": "2012-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA22339",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Jolla, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.