Healthcare Provider Details

I. General information

NPI: 1174179303
Provider Name (Legal Business Name): HAZEL LAYSON FNP-C, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 S ALAMEDA ST
COMPTON CA
90220-4973
US

IV. Provider business mailing address

12257 ECKLESON PL
CERRITOS CA
90703-7660
US

V. Phone/Fax

Practice location:
  • Phone: 949-295-4949
  • Fax:
Mailing address:
  • Phone: 949-295-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number745993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: