Healthcare Provider Details

I. General information

NPI: 1497166649
Provider Name (Legal Business Name): SHAYZAR HAWKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2014
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4025 W 226TH ST
TORRANCE CA
90505-2340
US

IV. Provider business mailing address

4025 W 226TH ST
TORRANCE CA
90505-2340
US

V. Phone/Fax

Practice location:
  • Phone: 310-373-4556
  • Fax:
Mailing address:
  • Phone: 310-373-4556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: