Healthcare Provider Details

I. General information

NPI: 1306721006
Provider Name (Legal Business Name): HAYDEN CANNON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11227 VALLEY BLVD STE 100
EL MONTE CA
91731-3299
US

IV. Provider business mailing address

1563 MISSION ST
SAN FRANCISCO CA
94103-2543
US

V. Phone/Fax

Practice location:
  • Phone: 626-444-0705
  • Fax:
Mailing address:
  • Phone: 415-762-3700
  • Fax: 415-865-0119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1623460725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: