Basic Information
| Provider Information | |||||||||
| NPI: | 1972807261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AYALA | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | COREEN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 314 WISCONSIN AVE | ||||||||
| Address2: | APARTMENT 25 | ||||||||
| City: | EL CAJON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920203453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7027139858 | ||||||||
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| Practice Location | |||||||||
| Address1: | 321 CASSIDY ST | ||||||||
| Address2: | |||||||||
| City: | OCEANSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920545314 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607212171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/01/2011 | ||||||||
| LastUpdateDate: | 10/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.