MEDICARE: DR. EZABELLE HAYEK DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DDS104382	CA

General Provider Information

NPI Number	:	1235789777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EZABELLE HAYEK DMD

Provider Business Mailing Address
First Line	:	2345 EAGLE CREEK LN
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-7772
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	24430 ALESSANDRO BLVD
Second Line	:
City	:	MORENO VALLEY
State	:	CA
Zip	:	92553-2435
Country	:	US
Telephone Number	:	951-601-0355
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/17/2019
Last Update Date	:	12/14/2021

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