Provider Demographics
NPI:1720803463
Name:BAYLOSIS, HAZELLE LAMA (NP)
Entity type:Individual
Prefix:
First Name:HAZELLE
Middle Name:LAMA
Last Name:BAYLOSIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 OCONNOR AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-4324
Mailing Address - Country:US
Mailing Address - Phone:619-508-5834
Mailing Address - Fax:
Practice Address - Street 1:1419 E 8TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2602
Practice Address - Country:US
Practice Address - Phone:619-718-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95032369363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology