Basic Information
| Provider Information | |||||||||
| NPI: | 1316579931 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAYDEL | ||||||||
| FirstName: | KENDALL | ||||||||
| MiddleName: | RAY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | II | ||||||||
| Credential: | PMH-NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13700 MARINA POINTE DR UNIT 822 | ||||||||
| Address2: | |||||||||
| City: | MARINA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902929263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372560188 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13160 MINDANAO WAY # 213 | ||||||||
| Address2: | |||||||||
| City: | MARINA DEL REY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902926358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242842440 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/11/2020 | ||||||||
| LastUpdateDate: | 03/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 95013912 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.