Healthcare Provider Details

I. General information

NPI: 1508703885
Provider Name (Legal Business Name): AYAA L SUBUH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1279 41ST AVE
SAN FRANCISCO CA
94122-1204
US

IV. Provider business mailing address

1279 41ST AVE
SAN FRANCISCO CA
94122-1204
US

V. Phone/Fax

Practice location:
  • Phone: 415-378-1922
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: