Provider Demographics
NPI:1700020864
Name:HAYNES, LEONA ELLEN (RN, NP)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:ELLEN
Last Name:HAYNES
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 ISLAND VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-3447
Mailing Address - Country:US
Mailing Address - Phone:361-658-1055
Mailing Address - Fax:
Practice Address - Street 1:5400 RALSTON ST
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6002
Practice Address - Country:US
Practice Address - Phone:805-644-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-20
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAY1-0431-3269261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health