Provider Demographics
NPI:1811374200
Name:HAK, MARADY (BSN)
Entity Type:Individual
Prefix:MRS
First Name:MARADY
Middle Name:
Last Name:HAK
Suffix:
Gender:F
Credentials:BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 KENTUCKY AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-3967
Mailing Address - Country:US
Mailing Address - Phone:619-937-8059
Mailing Address - Fax:
Practice Address - Street 1:350 KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3967
Practice Address - Country:US
Practice Address - Phone:619-937-8059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA822432163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse