Provider Demographics
NPI:1932998739
Name:PAXTON, HALEY CHANELLE
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:CHANELLE
Last Name:PAXTON
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 1:104 GOLD MINE DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2539
Mailing Address - Country:US
Mailing Address - Phone:925-886-9721
Mailing Address - Fax:
Practice Address - Street 1:104 GOLD MINE DR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2539
Practice Address - Country:US
Practice Address - Phone:925-886-9721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10252061133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered