Healthcare Provider Details

I. General information

NPI: 1396169629
Provider Name (Legal Business Name): AYRA OMNES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2014
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 N ANAHEIM BLVD
ANAHEIM CA
92801-1202
US

IV. Provider business mailing address

1325 N ANAHEIM BLVD
ANAHEIM CA
92801-1202
US

V. Phone/Fax

Practice location:
  • Phone: 888-499-9303
  • Fax:
Mailing address:
  • Phone: 888-499-9303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: