Provider Demographics
NPI:1992980593
Name:HYMEL, MARK S (MA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:HYMEL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 W A ST
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4850
Mailing Address - Country:US
Mailing Address - Phone:510-732-5977
Mailing Address - Fax:510-732-5954
Practice Address - Street 1:258 W A ST
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4850
Practice Address - Country:US
Practice Address - Phone:510-732-5977
Practice Address - Fax:510-732-5954
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8133Medicaid