Healthcare Provider Details

I. General information

NPI: 1558903807
Provider Name (Legal Business Name): CHRISTOPHER DIAZ AYUYAO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23845 MCBEAN PKWY
VALENCIA CA
91355-2083
US

IV. Provider business mailing address

3921 BOSTON DR
OXNARD CA
93033-6606
US

V. Phone/Fax

Practice location:
  • Phone: 661-200-1083
  • Fax:
Mailing address:
  • Phone: 805-204-1213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number664320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: