Provider Demographics
NPI:1497886055
Name:HAYES-MORA, RAYA ALISA (MS)
Entity Type:Individual
Prefix:
First Name:RAYA
Middle Name:ALISA
Last Name:HAYES-MORA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2641
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93002-2641
Mailing Address - Country:US
Mailing Address - Phone:925-348-4807
Mailing Address - Fax:
Practice Address - Street 1:400 CAMARILLO RANCH RD
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5901
Practice Address - Country:US
Practice Address - Phone:925-348-4807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47681106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA225400000XOtherREHABILITATION PRACTIONER