Provider Demographics
NPI:1336126614
Name:HAYATA, NANCY TOMOMI (DPM)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:TOMOMI
Last Name:HAYATA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7098 EDINGER AVE
Mailing Address - Street 2:BEACH CITIES PODIATRY GROUP INC
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647
Mailing Address - Country:US
Mailing Address - Phone:714-848-3663
Mailing Address - Fax:714-848-0565
Practice Address - Street 1:7098 EDINGER AVE
Practice Address - Street 2:BEACH CITIES PODIATRY GROUP INC
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647
Practice Address - Country:US
Practice Address - Phone:714-848-3663
Practice Address - Fax:714-848-0565
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4086213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOOE40860Medicaid
CAE4086Medicare ID - Type Unspecified
U71137Medicare UPIN