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General NPI Number Information
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NPI Number | 1255397063
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Entity Type | Individual
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Provider Name | JONATHAN MARKLAND HAYNES MD
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Gender | Male
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 130 CEDAR RD #220
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City | VISTA
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State | CA
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Zip | 92083-5102
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Country | US
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Telephone | 760-806-5520
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Fax |
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Provider Business Mailing Address
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Address Line | 503 S SIERRA AVE #161
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City | SOLANA BEACH
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State | CA
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Zip | 92075-2233
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Country | US
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Telephone | 858-752-1684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A81798
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License Number State | CA
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