Provider Demographics
NPI:1033348628
Name:DECLET, HYDEE B
Entity Type:Individual
Prefix:
First Name:HYDEE
Middle Name:B
Last Name:DECLET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3155 DE FOREST RD
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-2702
Mailing Address - Country:US
Mailing Address - Phone:831-384-1445
Mailing Address - Fax:
Practice Address - Street 1:1615 BUNKER HILL WAY
Practice Address - Street 2:SUITE #100
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-6010
Practice Address - Country:US
Practice Address - Phone:831-796-1304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHAP70655FMedicaid
CAFHC70655FMedicaid
CA1588617955OtherCLINIC NPI