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General NPI Number Information
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NPI Number | 1699481333
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Entity Type | Individual
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Provider Name | SANTIAGO M. AYALA LAC
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Gender | Male
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Dates
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Enumeration Date | 01/26/2023
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Last Update Date | 01/26/2023
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Provider Practice Location Address
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Address Line | 3303 E BASELINE RD STE 109
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City | GILBERT
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State | AZ
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Zip | 85234-2739
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Country | US
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Telephone | 480-278-5290
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Fax |
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Provider Business Mailing Address
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Address Line | 929 N VAL VISTA DR STE 109-151
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City | GILBERT
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State | AZ
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Zip | 85234-3706
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LAZC-16868
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License Number State | AZ
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