Healthcare Provider Details

I. General information

NPI: 1013878552
Provider Name (Legal Business Name): JESSICA HAYES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 CORONADO DR
COSTA MESA CA
92626-5634
US

IV. Provider business mailing address

963 CORONADO DR
COSTA MESA CA
92626-5634
US

V. Phone/Fax

Practice location:
  • Phone: 657-248-0498
  • Fax:
Mailing address:
  • Phone: 657-248-0498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: