Provider Demographics
NPI:1225244247
Name:BRUCE A. HAYTON, M.D., INC.
Entity Type:Organization
Organization Name:BRUCE A. HAYTON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-698-7514
Mailing Address - Street 1:36450 INLAND VALLEY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-9583
Mailing Address - Country:US
Mailing Address - Phone:951-698-7514
Mailing Address - Fax:951-698-8740
Practice Address - Street 1:36450 INLAND VALLEY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-9583
Practice Address - Country:US
Practice Address - Phone:951-698-7514
Practice Address - Fax:951-698-8740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55511174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G555110Medicaid
CAF78965Medicare UPIN
CA6131130001Medicare NSC
CA00G555110Medicaid
CACT412AMedicare PIN