Healthcare Provider Details

I. General information

NPI: 1215714902
Provider Name (Legal Business Name): HALEY MARIA RYDELSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7592 METROPOLITAN DR STE 404
SAN DIEGO CA
92108-4428
US

IV. Provider business mailing address

3853 MIDWAY DR APT 204
SAN DIEGO CA
92110-5221
US

V. Phone/Fax

Practice location:
  • Phone: 619-376-6653
  • Fax:
Mailing address:
  • Phone: 949-981-9764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: