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General NPI Number Information
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NPI Number | 1699456392
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Entity Type | Organization
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Legal Business Name | JENNIFER HAYHURST PHYSICIAN ASSISTANT APC
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Dates
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Enumeration Date | 07/26/2023
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Last Update Date | 10/12/2023
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Provider Practice Location Address
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Address Line | 1467 FORD ST STE 101
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City | REDLANDS
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State | CA
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Zip | 92373-3911
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Country | US
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Telephone | 909-551-3376
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Fax |
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Provider Business Mailing Address
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Address Line | 700 E REDLANDS BLVD STE U342
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City | REDLANDS
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State | CA
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Zip | 92373-6109
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Country | US
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Telephone | 909-551-3376
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JENNIFER HAYHURST
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Credential | PA-C
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Telephone | 949-836-1262
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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