Healthcare Provider Details

I. General information

NPI: 1063018141
Provider Name (Legal Business Name): HAILY NICOLE HELTON PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2020
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10837 LAUREL ST STE 204
RANCHO CUCAMONGA CA
91730-7657
US

IV. Provider business mailing address

10837 LAUREL ST STE 204
RANCHO CUCAMONGA CA
91730-7657
US

V. Phone/Fax

Practice location:
  • Phone: 909-294-5358
  • Fax:
Mailing address:
  • Phone: 909-294-5358
  • Fax: 909-294-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA59186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: