Healthcare Provider Details

I. General information

NPI: 1093469058
Provider Name (Legal Business Name): HAYLEY JEORGE ESDAILE RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2022
Last Update Date: 02/08/2022
Certification Date: 02/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 VILLAGE MEADOWS DR
LOMPOC CA
93436-3239
US

IV. Provider business mailing address

1213 VILLAGE MEADOWS DR
LOMPOC CA
93436-3239
US

V. Phone/Fax

Practice location:
  • Phone: 805-350-1638
  • Fax:
Mailing address:
  • Phone: 805-350-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: