Healthcare Provider Details

I. General information

NPI: 1497880330
Provider Name (Legal Business Name): JESSICA AYALA MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 07/19/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 EAST COLORADO BLVD 6TH FLOOR
PASADENA CA
91105
US

IV. Provider business mailing address

10428 LOWER AZUSA RD
EL MONTE CA
91731-1208
US

V. Phone/Fax

Practice location:
  • Phone: 626-861-1873
  • Fax:
Mailing address:
  • Phone: 626-453-3399
  • Fax: 626-453-3398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW78888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: