Provider Demographics
NPI:1417204900
Name:AYALA GONZALEZ, ELDA (MSW)
Entity type:Individual
Prefix:
First Name:ELDA
Middle Name:
Last Name:AYALA GONZALEZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3415 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-3648
Mailing Address - Country:US
Mailing Address - Phone:916-233-4910
Mailing Address - Fax:916-731-8149
Practice Address - Street 1:3415 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-3648
Practice Address - Country:US
Practice Address - Phone:916-233-4910
Practice Address - Fax:916-731-8149
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20-1867188OtherIEN