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NPI Code Detail

MEDICARE: HAILEY RENEE SEANZ FLETCHER

MEDICARE: HAILEY RENEE SEANZ FLETCHER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1003657735
Entity Type Code : Individual
Provider Name (Legal Business Name) : HAILEY RENEE SEANZ FLETCHER
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number : 818-345-2345
Fax Number :
Provider Business Practice Location Address
First Line : 19318 JESSE LN STE 100
Second Line :
City : RIVERSIDE
State : CA
Zip : 92508-5071
Country : US
Telephone Number : 951-900-7414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2024
Last Update Date : 06/05/2024

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Directions to “ HAILEY RENEE SEANZ FLETCHER ” Practice Location

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