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General NPI Number Information
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NPI Number | 1972650513
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Entity Type | Organization
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Legal Business Name | HAYWARD L EUBANKS M D A MEDICAL CORPORATION
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 4477 W 118TH STREET SUITE 205
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City | HAWTHORNE
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State | CA
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Zip | 90250-2255
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Country | US
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Telephone | 310-679-0676
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Fax | 310-679-0087
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Provider Business Mailing Address
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Address Line | 5529 SECREST DRIVE
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City | LOS ANGELES
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State | CA
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Zip | 90043-2029
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Country | US
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Telephone | 310-679-0676
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Fax | 323-296-4776
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Authorized Official
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Title or Position | PRACTICE MANAGER, ACCESS MANAGER
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Name | MS. BRITTANY LYNITA EUBANKS
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Credential | LCSW
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Telephone | 310-908-1842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | G54388
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License Number State | CA
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