Provider Demographics
NPI:1245602952
Name:HAYES, WENDY (CMA (AAMA))
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:HAYES
Suffix:
Gender:F
Credentials:CMA (AAMA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N LANGSTAFF ST
Mailing Address - Street 2:UNIT A
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-3713
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 GOLDEN SHR
Practice Address - Street 2:SUITE 250
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-4246
Practice Address - Country:US
Practice Address - Phone:562-256-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-21
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2466900261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center