Healthcare Provider Details

I. General information

NPI: 1376447912
Provider Name (Legal Business Name): YESENIA HAYDEN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 EL CAJON BLVD
EL CAJON CA
92020-5714
US

IV. Provider business mailing address

4372 W POINT LOMA BLVD APT B
SAN DIEGO CA
92107-1188
US

V. Phone/Fax

Practice location:
  • Phone: 619-662-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86114509
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: