Provider Demographics
NPI:1609402601
Name:HAYES, CRYSTAL MARIE (RD)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:MARIE
Last Name:HAYES
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:CRYSTAL
Other - Middle Name:MARIE
Other - Last Name:LEATHERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18 PETAR LN
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-4872
Mailing Address - Country:US
Mailing Address - Phone:925-330-1010
Mailing Address - Fax:
Practice Address - Street 1:18 PETAR LN
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4872
Practice Address - Country:US
Practice Address - Phone:925-330-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-21
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86087639133V00000X
OR86087639133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered