Provider Demographics
NPI:1639503394
Name:HAYES, WILLIAM BYRON III (LCMT, HHP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BYRON
Last Name:HAYES
Suffix:III
Gender:M
Credentials:LCMT, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5904 ADELAIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5421
Mailing Address - Country:US
Mailing Address - Phone:310-623-0261
Mailing Address - Fax:
Practice Address - Street 1:2214 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-2104
Practice Address - Country:US
Practice Address - Phone:619-488-7779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X, 173C00000X, 225700000X
CA4062174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist
No174400000XOther Service ProvidersSpecialist