Healthcare Provider Details

I. General information

NPI: 1083551089
Provider Name (Legal Business Name): DAUNTE HAYNES ED.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 30TH ST
SAN DIEGO CA
92102-3090
US

IV. Provider business mailing address

500 30TH ST
SAN DIEGO CA
92102-3090
US

V. Phone/Fax

Practice location:
  • Phone: 619-704-1020
  • Fax:
Mailing address:
  • Phone: 619-704-1020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number210250327
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: