Healthcare Provider Details

I. General information

NPI: 1770109001
Provider Name (Legal Business Name): MARIBEL AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16580 HARBOR BLVD STE M
FOUNTAIN VALLEY CA
92708-1385
US

IV. Provider business mailing address

16580 HARBOR BLVD STE M
FOUNTAIN VALLEY CA
92708-1385
US

V. Phone/Fax

Practice location:
  • Phone: 714-659-6380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number103544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: