Healthcare Provider Details

I. General information

NPI: 1124984810
Provider Name (Legal Business Name): LARISSA AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/26/2025
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 LAUREL ST
NAPA CA
94558-5629
US

IV. Provider business mailing address

3140 LAUREL ST
NAPA CA
94558-5629
US

V. Phone/Fax

Practice location:
  • Phone: 707-415-9008
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: