Healthcare Provider Details

I. General information

NPI: 1437061314
Provider Name (Legal Business Name): DIANA AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 MARIA DR
PETALUMA CA
94954-2301
US

IV. Provider business mailing address

845 CRINELLA DR
PETALUMA CA
94954-4499
US

V. Phone/Fax

Practice location:
  • Phone: 707-765-4321
  • Fax:
Mailing address:
  • Phone: 707-765-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: