Healthcare Provider Details

I. General information

NPI: 1922137173
Provider Name (Legal Business Name): MARIA VIRGINIA GARCIA SIOSON-AYALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10418 VALLEY BLVD
EL MONTE CA
91731-3600
US

IV. Provider business mailing address

1490 E DEL MAR BLVD
PASADENA CA
91106-2704
US

V. Phone/Fax

Practice location:
  • Phone: 626-453-8466
  • Fax: 626-453-8465
Mailing address:
  • Phone: 626-993-0260
  • Fax: 626-529-3749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA105436
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: