Healthcare Provider Details

I. General information

NPI: 1598876849
Provider Name (Legal Business Name): HEIDI PARADELA-AYAP MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 NORTH JACKSON AVENUE SUITE 101
SAN JOSE CA
95116-1924
US

IV. Provider business mailing address

115 NORTH JACKSON AVENUE SUITE 101
SAN JOSE CA
95116-1924
US

V. Phone/Fax

Practice location:
  • Phone: 408-347-8068
  • Fax: 408-347-8612
Mailing address:
  • Phone: 408-347-8068
  • Fax: 408-347-8612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA52631
License Number StateCA

VIII. Authorized Official

Name: HEIDI PARADELA AYAP
Title or Position: PRESIDENT
Credential: MD
Phone: 408-347-8068