Healthcare Provider Details

I. General information

NPI: 1700344272
Provider Name (Legal Business Name): JAZMINE AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2019
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12459 LEWIS ST STE 201
GARDEN GROVE CA
92840-6606
US

IV. Provider business mailing address

12459 LEWIS ST STE 201
GARDEN GROVE CA
92840-6606
US

V. Phone/Fax

Practice location:
  • Phone: 800-249-1266
  • Fax:
Mailing address:
  • Phone: 800-249-1266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2853736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: