Healthcare Provider Details

I. General information

NPI: 1497511596
Provider Name (Legal Business Name): PABLO AYALA MSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 01/28/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 W 7TH ST
SAN PEDRO CA
90731-3320
US

IV. Provider business mailing address

1360 W 6TH ST STE 200
SAN PEDRO CA
90732-3561
US

V. Phone/Fax

Practice location:
  • Phone: 310-519-6100
  • Fax:
Mailing address:
  • Phone: 310-519-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number94632
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number94632
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: