TRACY HAZELTON


Address: 15322 Lakeshore Dr, Suite 101, Clearlake, CA 95422-9814
Phone: 7079951362

TRACY HAZELTON (NPI# 1821024746) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363AM0700X Physician Assistant
Specialization: Medical
PA13690 CA Physician Assistants & Advanced Practice Nursing Providers

Office Location

Street Address 15322 LAKESHORE DR
SUITE 101
City CLEARLAKE
State CA
Zip Code 95422-9814

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363AM0700X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Physician Assistant
Specialization Medical

Taxonomy Definition

Definition to come...

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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
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Competitor

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City CLEARLAKE
Zip Code 95422

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Dataset Information

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.

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