Provider Demographics
NPI:1568293165
Name:AYALA, MAIRANY L
Entity type:Individual
Prefix:
First Name:MAIRANY
Middle Name:L
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 1:444 S 8TH ST STE B3
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-3236
Mailing Address - Country:US
Mailing Address - Phone:760-353-6571
Mailing Address - Fax:
Practice Address - Street 1:444 S 8TH ST STE B3
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3236
Practice Address - Country:US
Practice Address - Phone:760-353-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAC5BF-03-05-S24-020172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator