Healthcare Provider Details

I. General information

NPI: 1801246749
Provider Name (Legal Business Name): KAREN AYALA ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2812 E MILLBRAE AVE
FRESNO CA
93710-4825
US

IV. Provider business mailing address

2812 E MILLBRAE AVE
FRESNO CA
93710-4825
US

V. Phone/Fax

Practice location:
  • Phone: 559-940-1292
  • Fax:
Mailing address:
  • Phone: 559-940-1292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000009139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: