Healthcare Provider Details

I. General information

NPI: 1114838349
Provider Name (Legal Business Name): JAMES ANTENOR HAYES SUDRC II - #19141
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 IRWIN ST STE 302
SAN RAFAEL CA
94901-3343
US

IV. Provider business mailing address

851 IRWIN ST STE 302
SAN RAFAEL CA
94901-3343
US

V. Phone/Fax

Practice location:
  • Phone: 415-685-5783
  • Fax:
Mailing address:
  • Phone: 415-686-5783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number19141
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: