Provider Demographics
NPI:1912966474
Name:HALEY, DAVID KEIKI MAI LANI LOUIS SR (IDC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:KEIKI MAI LANI LOUIS
Last Name:HALEY
Suffix:SR
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 SEAL BEACH BLVD
Mailing Address - Street 2:BLDG 77
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5607
Mailing Address - Country:US
Mailing Address - Phone:562-626-6296
Mailing Address - Fax:562-626-6290
Practice Address - Street 1:800 SEAL BEACH BLVD
Practice Address - Street 2:BLDG 77
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5607
Practice Address - Country:US
Practice Address - Phone:562-626-6296
Practice Address - Fax:562-626-6290
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA040819701988OtherINDEPENDENT DUTY CORPSMAN