Provider Demographics
NPI:1003268350
Name:JAYNES, HILLARY (LAC)
Entity type:Individual
Prefix:
First Name:HILLARY
Middle Name:
Last Name:JAYNES
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:MS
Other - First Name:HILLARY
Other - Middle Name:ANNE
Other - Last Name:JAYNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:621 E CAMPBELL AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-2126
Mailing Address - Country:US
Mailing Address - Phone:408-320-6791
Mailing Address - Fax:
Practice Address - Street 1:621 E CAMPBELL AVE STE 12
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2126
Practice Address - Country:US
Practice Address - Phone:408-320-6791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13896171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist