=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932325792
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAWN M HAYES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/18/2007
-----------------------------------------------------
Last Update Date | 08/24/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1907 DOUGLAS BLVD STE 70
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661-3808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-783-0101
-----------------------------------------------------
Fax | 916-783-6049
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1907 DOUGLAS BLVD STE 70
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95661-3808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-783-0101
-----------------------------------------------------
Fax | 916-783-6049
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SHELLY A ALBURY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 916-783-0101
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------