Healthcare Provider Details

I. General information

NPI: 1972099703
Provider Name (Legal Business Name): LUCAS M DE AYORA MS CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 CREEKVIEW DR
MERCED CA
95340-8216
US

IV. Provider business mailing address

2391 CREEKVIEW DR
MERCED CA
95340-8216
US

V. Phone/Fax

Practice location:
  • Phone: 209-819-7008
  • Fax:
Mailing address:
  • Phone: 209-819-7008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number20129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: