Provider Demographics
NPI:1366608457
Name:HAYNES, JILL (AESTHETICIAN)
Entity type:Individual
Prefix:MISS
First Name:JILL
Middle Name:
Last Name:HAYNES
Suffix:
Gender:F
Credentials:AESTHETICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 STOCKTON BLVD STE 7200
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2207
Mailing Address - Country:US
Mailing Address - Phone:916-734-2347
Mailing Address - Fax:916-734-7268
Practice Address - Street 1:2521 STOCKTON BLVD STE 7200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-2437
Practice Address - Fax:916-734-7268
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAZ33486171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator