Provider Demographics
NPI:1083834527
Name:AYALA, BLANCA ROSA (BA)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:ROSA
Last Name:AYALA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16441 WATERWAY CIR APT A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-3252
Mailing Address - Country:US
Mailing Address - Phone:714-840-0563
Mailing Address - Fax:
Practice Address - Street 1:1615 FRENCH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2475
Practice Address - Country:US
Practice Address - Phone:714-824-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist