Healthcare Provider Details

I. General information

NPI: 1518608751
Provider Name (Legal Business Name): RICARDO ANTONIO AYALA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2022
Last Update Date: 04/03/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N BRIDGE ST
VISALIA CA
93291-5014
US

IV. Provider business mailing address

24570 STEWART ST APT H10
LOMA LINDA CA
92354-2700
US

V. Phone/Fax

Practice location:
  • Phone: 877-960-3426
  • Fax:
Mailing address:
  • Phone: 425-533-7131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number1111111
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: