Provider Demographics
NPI:1083896732
Name:AYALA, MARTA ROSA
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:ROSA
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 1:12322 CLEARGLEN AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-3872
Mailing Address - Country:US
Mailing Address - Phone:562-947-3835
Mailing Address - Fax:562-947-9895
Practice Address - Street 1:12322 CLEARGLEN AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-3872
Practice Address - Country:US
Practice Address - Phone:562-947-3835
Practice Address - Fax:562-947-9895
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)