Provider Demographics
NPI:1891747812
Name:HAYWARD, ULRIKE M (MD)
Entity Type:Individual
Prefix:
First Name:ULRIKE
Middle Name:M
Last Name:HAYWARD
Suffix:
Gender:F
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:PO BOX 15778
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-5778
Mailing Address - Country:US
Mailing Address - Phone:949-263-8620
Mailing Address - Fax:949-263-0473
Practice Address - Street 1:2320 BATH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4339
Practice Address - Country:US
Practice Address - Phone:805-682-7984
Practice Address - Fax:805-569-2964
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA760842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A760840OtherBLUE SHIELD OF CA
CA00A760840Medicaid
CAWA76084Medicare PIN
CA00A760840Medicaid