Healthcare Provider Details

I. General information

NPI: 1639613151
Provider Name (Legal Business Name): GINNETTE AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RIVER BIRCH CT APT 522
CLERMONT FL
34711-5142
US

IV. Provider business mailing address

600 RIVER BIRCH CT APT 522
CLERMONT FL
34711-5142
US

V. Phone/Fax

Practice location:
  • Phone: 787-405-6448
  • Fax:
Mailing address:
  • Phone: 787-405-6448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: