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General NPI Number Information
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NPI Number | 1689561276
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Entity Type | Individual
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Provider Name | NICOLE DIANE AYALA
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Gender | Female
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Dates
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Enumeration Date | 06/18/2025
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 9412 BIG HORN BLVD STE 69412
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City | ELK GROVE
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State | CA
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Zip | 95758-1101
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Country | US
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Telephone | 916-609-5100
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Fax |
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Provider Business Mailing Address
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Address Line | 8779 ELK WAY
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City | ELK GROVE
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State | CA
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Zip | 95624-1651
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Country | US
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Telephone | 916-873-9793
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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