Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1013147008 |
---|---|
Provider Name | Stephania Lyn Hayes |
First Address | Los Angeles, CA 90007-3760 |
Second Address | Los Angeles, CA 90057-4303 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2009 |
Last Update Date | 23/07/2009 |