Basic Information
| Provider Information | |||||||||
| NPI: | 1922539865 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HADLEY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DENNIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD, MBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9909 MIRA MESA BLVD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921311056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586577750 | ||||||||
| FaxNumber: | 8585662431 | ||||||||
| Practice Location | |||||||||
| Address1: | 477 N EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920241328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604793900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2017 | ||||||||
| LastUpdateDate: | 06/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 157438 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.