Healthcare Provider Details

I. General information

NPI: 1184552242
Provider Name (Legal Business Name): AYLA CHASE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 E 21ST ST
OGDEN UT
84401-0732
US

IV. Provider business mailing address

1132 E 21ST ST
OGDEN UT
84401-0732
US

V. Phone/Fax

Practice location:
  • Phone: 321-271-5947
  • Fax:
Mailing address:
  • Phone: 321-271-5947
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14065425-3102
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: