Healthcare Provider Details

I. General information

NPI: 1346104809
Provider Name (Legal Business Name): ASHLEY M AYESTAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

685 N 13TH AVE STE 2
UPLAND CA
91786-4963
US

IV. Provider business mailing address

685 N 13TH AVE
UPLAND CA
91786-4916
US

V. Phone/Fax

Practice location:
  • Phone: 909-500-8683
  • Fax:
Mailing address:
  • Phone: 909-500-8683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA67990
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: