Provider Demographics
NPI:1124608856
Name:HUGHES, HAYLEY LEANNE (RDN)
Entity type:Individual
Prefix:
First Name:HAYLEY
Middle Name:LEANNE
Last Name:HUGHES
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 ARDMORE CIR
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-6205
Mailing Address - Country:US
Mailing Address - Phone:760-623-3264
Mailing Address - Fax:
Practice Address - Street 1:350 TERRACINA BLVD
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4850
Practice Address - Country:US
Practice Address - Phone:909-335-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2024-10-25
Deactivation Date:2024-05-13
Deactivation Code:
Reactivation Date:2024-08-29
Provider Licenses
StateLicense IDTaxonomies
CA86092312133V00000X
CAPA65243363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered