Provider Demographics
NPI:1942287180
Name:HAYES, CARL ERIC (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:ERIC
Last Name:HAYES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E VIRGINIA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5857
Mailing Address - Country:US
Mailing Address - Phone:408-918-2600
Mailing Address - Fax:408-579-6143
Practice Address - Street 1:4004 S VERMONT AVE
Practice Address - Street 2:STE #6
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037
Practice Address - Country:US
Practice Address - Phone:323-232-6686
Practice Address - Fax:323-232-6626
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G66485207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G664851Medicaid
CA00G664851Medicaid