MEDICARE: CELIA HAYWOOD

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	163W00000X	Registered Nurse	528063	CA

General Provider Information

NPI Number	:	1346507407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELIA HAYWOOD

Provider Business Mailing Address
First Line	:	2474 MADRONCILLO ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-1625
Country	:	US
Telephone Number	:	619-887-6024
Fax Number	:

Provider Business Practice Location Address
First Line	:	2474 MADRONCILLO ST.
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-1625
Country	:	US
Telephone Number	:	619-887-6024
Fax Number	:

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

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	04/13/2012

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Directions to “ CELIA HAYWOOD ” Practice Location

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