Kevin Daryl Hazel

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

51342 Issued in CA

Practice address

15373 Innovation Dr Ste 220
San Diego, CA 92128-3425

Phone

(858) 592-8855

NPI assigned

Nov 20, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1637366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637366400000",
    "number": "1831856210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "724 DENNIS AVE",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919106215",
            "telephone_number": "619-762-0610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15373 INNOVATION DR STE 220",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921283425",
            "telephone_number": "858-592-8855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAZEL",
        "first_name": "KEVIN",
        "middle_name": "DARYL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-11-20",
        "last_updated": "2021-11-20",
        "certification_date": "2021-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "CA",
            "license": "51342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Savannah Hayward
• Celia Haywood
• Stacey Ann Haywood, MSW
• Umer Hayyat, MD
• Victoria Marie Hazard
• Tiffany Nicole Hazel
• Paul Nolan Hazelbaker, DO
• Hazelden Betty Ford Foundation
• Crystal Hazelton, MPT
• Elizabeth Lynne Hazelton, RCP, RRT

• Physical Therapy Assistant in San Diego, CA
• Providers in San Diego, CA by specialty
• Physical Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.