MEDICARE: HAYDEN SETH JAMES IDC

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	1710I1002X	Independent Duty Corpsman

General Provider Information

NPI Number	:	1417735739
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAYDEN SETH JAMES IDC

Provider Business Mailing Address
First Line	:	312 PALM AVE APT 101
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-1783
Country	:	US
Telephone Number	:	904-993-7976
Fax Number	:

Provider Business Practice Location Address
First Line	:	312 PALM AVE APT 101
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-1783
Country	:	US
Telephone Number	:	904-993-7976
Fax Number	:

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

Provider Enumeration Date	:	09/18/2023
Last Update Date	:	09/18/2023

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