Provider Demographics
NPI:1003115106
Name:HAYES, JEWEL A (LAC)
Entity Type:Individual
Prefix:
First Name:JEWEL
Middle Name:A
Last Name:HAYES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4737 W MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1611
Mailing Address - Country:US
Mailing Address - Phone:914-649-9583
Mailing Address - Fax:
Practice Address - Street 1:3594 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5017
Practice Address - Country:US
Practice Address - Phone:619-564-8308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-15
Last Update Date:2011-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13496171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist