Healthcare Provider Details

I. General information

NPI: 1700715174
Provider Name (Legal Business Name): RITA HAYDAW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1164 FARVIEW CT
EL CAJON CA
92021-4665
US

IV. Provider business mailing address

44100 TOWN CENTER WAY STE A3
PALM DESERT CA
92260-2763
US

V. Phone/Fax

Practice location:
  • Phone: 619-729-7881
  • Fax:
Mailing address:
  • Phone: 760-469-2563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113389
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: