Healthcare Provider Details

I. General information

NPI: 1205767514
Provider Name (Legal Business Name): ROSA LIDIA AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4521 WEBSTER ST
OAKLAND CA
94609-2140
US

IV. Provider business mailing address

4521 WEBSTER ST
OAKLAND CA
94609-2140
US

V. Phone/Fax

Practice location:
  • Phone: 510-879-1353
  • Fax:
Mailing address:
  • Phone: 510-979-1353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: