Provider Demographics
NPI:1336606482
Name:HAYL NUTRITION & WELLNESS
Entity Type:Organization
Organization Name:HAYL NUTRITION & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ADI
Authorized Official - Middle Name:TOVA
Authorized Official - Last Name:WYSHOGROD
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:508-736-5453
Mailing Address - Street 1:3950 LELAND ST APT C10
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-1043
Mailing Address - Country:US
Mailing Address - Phone:508-736-5453
Mailing Address - Fax:
Practice Address - Street 1:3950 LELAND ST APT C10
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-1043
Practice Address - Country:US
Practice Address - Phone:508-736-5453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-25
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty