TRACY HAZELTON (NPI# 1821024746) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1821024746 |
Entity Type | Individual |
Full Name | TRACY HAZELTON |
Credential | PA |
Practice Address |
15322 Lakeshore Dr Suite 101 Clearlake CA 95422-9814 |
Practice Telephone | 7079951362 |
Practice Fax Number | 7079951362 |
Mailing Telephone | 7079951362 |
Mailing Fax Number | 7079951362 |
Enumeration Date | 2006-06-23 |
Last Update Date | 2009-04-17 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA13690 | CA | Physician Assistants & Advanced Practice Nursing Providers |
Street Address |
15322 LAKESHORE DR SUITE 101 |
City | CLEARLAKE |
State | CA |
Zip Code | 95422-9814 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1801898929 | Mark J Freeman | Family Medicine | 15322 Lakeshore Dr, Ste 101, Clearlake, CA 95422-9815 | 2005-06-01 |
1760871230 | Adventist Health Physicians Network | Surgery | 15322 Lakeshore Dr, Suite 101, Clearlake, CA 95422-9814 | 2015-01-21 |
1508153321 | Adventist Health California Medical Group, Inc. | Family Medicine | 15322 Lakeshore Dr, Suite 202, Clearlake, CA 95422-9814 | 2011-06-30 |
1659668473 | Adventist Health California Medical Group, Inc. | Family Medicine | 15322 Lakeshore Dr, Suite 201, Clearlake, CA 95422-9814 | 2011-06-30 |
1588961676 | Adventist Health Physicians Network | Internal Medicine | 15322 Lakeshore Dr, Suite 201, Clearlake, CA 95422-9814 | 2011-02-25 |
1023315116 | Adventist Health Physician Network | Family Medicine | 15322 Lakeshore Dr, Suite 202, Clearlake, CA 95422-9814 | 2011-02-25 |
1992002083 | Adventist Health Physicians Network | Clinic/Center | 15322 Lakeshore Dr, Suite 102, Clearlake, CA 95422-9814 | 2011-02-25 |
1134426364 | Adventist Health Physicians Network | Obstetrics & Gynecology | 15322 Lakeshore Dr, Clearlake, CA 95422-9814 | 2011-02-24 |
1346565173 | Adventist Health California Medical Group, Inc. | Family Medicine | 15322 Lakeshore Dr, Suite 201, Clearlake, CA 95422-9814 | 2010-04-05 |
1154646982 | Adventist Health California Medical Group, Inc. | Urology | 15322 Lakeshore Dr, Suite 203, Clearlake, CA 95422-9814 | 2010-04-05 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1831729201 | Richard Charles Hammond | Counselor | 7000 B South Center Drive, Clearlake, CA 95422 | 2020-01-24 |
1609416437 | Junirose Thom | Behavioral Analyst | 4456 Manzanita Avenue Suite 2, Clearlake, CA 95422 | 2020-01-09 |
1649781360 | Lake County Office of Education | Local Education Agency (LEA) | 3350 Acacia St, Clearlake, CA 95422 | 2017-10-20 |
1083091326 | Noelle Menesini | Physician Assistant | 15230 Lake Shore Drive, Clearlake, CA 95422 | 2015-05-06 |
1861820979 | Lake County Office of Education | Local Education Agency (LEA) | 6945 Old Highway 53, Clearlake, CA 95422 | 2013-10-29 |
1124469838 | Hassan Sheikh Moghaddas | Surgery | 15332 Lakeshore Dr Ste 101, Clearlake, CA 95422 | 2013-07-10 |
1366710279 | Nancy Bylund | Licensed Psychiatric Technician | 7000b South Center Drive, Clearlake, CA 95422 | 2011-12-06 |
1699060830 | Planned Parenthood Shasta Pacific | Clinic/Center | 1437 Olympic Drive, Cleaklake, CA 95422 | 2011-06-16 |
1164655247 | Hector Lara | Counselor | 14130 Lakeshore Dr., Clearlake, CA 95422 | 2009-08-24 |
1518197607 | Vishal V Desai | Pharmacist | 15025, Olympic Drive, Clearlake, CA 95422 | 2009-07-23 |
Find all providers in zip 95422 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1760089437 | Karine Harutyunyan | Physician Assistant | 500 E Colorado St Ste 101, Glendale, CA 91205-1607 | 2020-10-06 |
1437756228 | Kale Burket | Physician Assistant | Bldg 523, S 8th St, El Centro, CA 92243 | 2020-10-05 |
1548867666 | Heba Marzouk Al-shoubaki | Physician Assistant | 633 S Pepper St, Anaheim, CA 92802-1459 | 2020-10-01 |
1275140550 | Lisa Lynn Passalacqua | Physician Assistant | 431 7th St, Norco, CA 92860-1671 | 2020-09-30 |
1144833989 | Trisha Taylor | Physician Assistant | 10399 Tivoli Way, Yucaipa, CA 92399-6017 | 2020-08-30 |
1457963944 | Harlan William Monahan | Physician Assistant | 5210 Del Rio Rd, Sacramento, CA 95822-2519 | 2020-08-18 |
1275144313 | Sofia Carmen Bustillo | Physician Assistant | 1709 Coral Pl, Seal Beach, CA 90740-5712 | 2020-08-12 |
1124638663 | Gayaneh Gharakhani | Physician Assistant | 1323 E Broadway Apt 110, Glendale, CA 91205-4018 | 2020-08-07 |
1144830183 | Loc Bao Tran | Physician Assistant | 8937 Emerson Pl, Rosemead, CA 91770-2813 | 2020-08-04 |
1558997957 | Sarah Lubinsky | Physician Assistant | 1511 Montana Ave, Santa Monica, CA 90403-1891 | 2020-03-17 |
Find all providers with the same taxonomy |
Please comment or provide details below to improve the information on TRACY HAZELTON.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.