MEDICARE: JULISSA HAYA NP

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
1	363LP0200X	Pediatric Nurse Practitioner	95021910	CA

General Provider Information

NPI Number	:	1144911322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULISSA HAYA NP

Provider Business Mailing Address
First Line	:	900 COLUSA AVE STE 204
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94707-2321
Country	:	US
Telephone Number	:	510-465-4445
Fax Number	:	510-208-0437

Provider Business Practice Location Address
First Line	:	900 COLUSA AVE STE 204
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94707-2321
Country	:	US
Telephone Number	:	510-465-4445
Fax Number	:	510-208-0437

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2023
Last Update Date	:	05/17/2023

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