Healthcare Provider Details

I. General information

NPI: 1407769771
Provider Name (Legal Business Name): ASHLEY WALLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 CARNEGIE AVE STE 1C
SANTA ANA CA
92705-5504
US

IV. Provider business mailing address

562 E H ST
ONTARIO CA
91764-3328
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-8319
  • Fax:
Mailing address:
  • Phone: 626-491-9347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: