Provider Demographics
NPI:1982030821
Name:HAYDEN, LISE SLOAN
Entity Type:Individual
Prefix:
First Name:LISE
Middle Name:SLOAN
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 N FIGUEROA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90042-4227
Mailing Address - Country:US
Mailing Address - Phone:323-274-1070
Mailing Address - Fax:323-982-1575
Practice Address - Street 1:5809 N FIGUEROA ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-4227
Practice Address - Country:US
Practice Address - Phone:323-274-1070
Practice Address - Fax:323-982-1575
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker