Provider Demographics
NPI:1710030192
Name:HAYTON, BRUCE A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:HAYTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36450 INLAND VALLEY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-9583
Mailing Address - Country:US
Mailing Address - Phone:951-698-7514
Mailing Address - Fax:951-698-8740
Practice Address - Street 1:36450 INLAND VALLEY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595
Practice Address - Country:US
Practice Address - Phone:951-698-7514
Practice Address - Fax:951-698-8740
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2018-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55511207R00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G555110Medicaid
CACT412AMedicare PIN
CA00G555110Medicare ID - Type Unspecified
CA6131130001Medicare NSC
CAZZZ23037ZMedicare ID - Type Unspecified
CA00G555110Medicaid