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General NPI Number Information
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NPI Number | 1649664079
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Entity Type | Individual
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Provider Name | JENNIFER DARLENE HAYHURST P.A.-C.
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Gender | Female
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Dates
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Enumeration Date | 03/24/2015
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 124 E. OLIVE AVE.
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City | REDLANDS
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State | CA
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Zip | 92373
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Country | US
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Telephone | 909-798-9403
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Fax | 909-335-1641
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Provider Business Mailing Address
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Address Line | 25815 BARTON RD STE 101
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City | LOMA LINDA
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State | CA
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Zip | 92354-3894
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Country | US
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Telephone | 909-796-0224
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA52146
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License Number State | CA
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