Healthcare Provider Details

I. General information

NPI: 1720323637
Provider Name (Legal Business Name): LORALEI AYALA LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2012
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29325 KIMBERLINA RD
WASCO CA
93280
US

IV. Provider business mailing address

901 22ND AVE APT F8
DELANO CA
93215-4800
US

V. Phone/Fax

Practice location:
  • Phone: 661-758-4029
  • Fax: 661-758-0891
Mailing address:
  • Phone: 661-709-5065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number268943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: