Healthcare Provider Details

I. General information

NPI: 1184972226
Provider Name (Legal Business Name): ROBERTA JOY HAYERTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2012
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 PRINTZ RD
ARROYO GRANDE CA
93420-5026
US

IV. Provider business mailing address

PO BOX 1419
ARROYO GRANDE CA
93421-1419
US

V. Phone/Fax

Practice location:
  • Phone: 805-473-0297
  • Fax:
Mailing address:
  • Phone: 805-473-0297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA-25515
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA-25515
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA-25515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: