Healthcare Provider Details

I. General information

NPI: 1245176619
Provider Name (Legal Business Name): AILYN D DURRUTHY ELIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 S VINEYARD
MESA AZ
85210-6889
US

IV. Provider business mailing address

2045 S VINEYARD STE 123
MESA AZ
85210-6893
US

V. Phone/Fax

Practice location:
  • Phone: 480-656-3530
  • Fax:
Mailing address:
  • Phone: 480-656-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: