Healthcare Provider Details

I. General information

NPI: 1831442755
Provider Name (Legal Business Name): HEIDI JANAE AYALA MEDICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

942 S ATLANTIC BLVD NONE
LOS ANGELES CA
90022-4004
US

IV. Provider business mailing address

1028 S TOWNSEND AVE NONE
LOS ANGELES CA
90023-2420
US

V. Phone/Fax

Practice location:
  • Phone: 323-263-9700
  • Fax: 323-263-8042
Mailing address:
  • Phone: 323-263-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: