Provider Demographics
NPI:1871626358
Name:HAYNES, RAQUEL DIANE
Entity type:Individual
Prefix:MS
First Name:RAQUEL
Middle Name:DIANE
Last Name:HAYNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 W 43RD PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-5256
Mailing Address - Country:US
Mailing Address - Phone:323-295-4158
Mailing Address - Fax:
Practice Address - Street 1:3211 W 43RD PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90008-5256
Practice Address - Country:US
Practice Address - Phone:323-295-4158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator