Healthcare Provider Details

I. General information

NPI: 1558673566
Provider Name (Legal Business Name): LAYA NASROLLAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 SANTA ROSA RD STE 149
CAMARILLO CA
93012-7061
US

IV. Provider business mailing address

1501 N CAMPBELL AVE RM 6336
TUCSON AZ
85724-5040
US

V. Phone/Fax

Practice location:
  • Phone: 805-469-8900
  • Fax: 805-469-8920
Mailing address:
  • Phone: 520-626-2761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA142119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: