Healthcare Provider Details

I. General information

NPI: 1255274668
Provider Name (Legal Business Name): DIANA CAMILA AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3767 CENTRAL AVE
SAN DIEGO CA
92105-2599
US

IV. Provider business mailing address

4645 ARIZONA ST APT 3
SAN DIEGO CA
92116-5913
US

V. Phone/Fax

Practice location:
  • Phone: 619-278-0777
  • Fax:
Mailing address:
  • Phone: 760-557-9646
  • 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 State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: