Healthcare Provider Details

I. General information

NPI: 1194001990
Provider Name (Legal Business Name): MARISA ELIZABETH AYERS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

697 W TEFFT ST
NIPOMO CA
93444-9190
US

IV. Provider business mailing address

935 NEWPORT AVE
GROVER BEACH CA
93433-1711
US

V. Phone/Fax

Practice location:
  • Phone: 805-929-2272
  • Fax: 805-929-1454
Mailing address:
  • Phone: 805-704-8943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21792
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: