Provider Demographics
NPI:1093469058
Name:ESDAILE, HAYLEY JEORGE (RD)
Entity Type:Individual
Prefix:
First Name:HAYLEY
Middle Name:JEORGE
Last Name:ESDAILE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 VILLAGE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-3239
Mailing Address - Country:US
Mailing Address - Phone:805-350-1638
Mailing Address - Fax:
Practice Address - Street 1:1213 VILLAGE MEADOWS DR
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-3239
Practice Address - Country:US
Practice Address - Phone:805-350-1638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered