Provider Demographics
NPI:1427544758
Name:HAYWOOD, CHRISTINA LEILANI (LAC)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:LEILANI
Last Name:HAYWOOD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 NE REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4059
Mailing Address - Country:US
Mailing Address - Phone:541-728-3790
Mailing Address - Fax:
Practice Address - Street 1:335 NE REVERE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4059
Practice Address - Country:US
Practice Address - Phone:541-728-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR189091171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty