Healthcare Provider Details

I. General information

NPI: 1225345952
Provider Name (Legal Business Name): MRS. AYANNA KAIA SCOTT-HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MISS AYANNA KAIA SCOTT

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81840 AVENUE 46 SUITE 201
INDIO CA
92201-3936
US

IV. Provider business mailing address

2705 HIGHLAND AVE
SELMA CA
93662-3389
US

V. Phone/Fax

Practice location:
  • Phone: 760-391-6999
  • Fax: 760-391-6998
Mailing address:
  • Phone: 800-492-4227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: