Provider Demographics
NPI:1154896843
Name:AYALA, ESTEPHANIE ERIKA
Entity type:Individual
Prefix:
First Name:ESTEPHANIE
Middle Name:ERIKA
Last Name:AYALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13631 IRONSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-8819
Mailing Address - Country:US
Mailing Address - Phone:760-927-5099
Mailing Address - Fax:
Practice Address - Street 1:13631 IRONSTONE AVE
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92392-8819
Practice Address - Country:US
Practice Address - Phone:760-927-5099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician