Provider Demographics
NPI:1093494908
Name:AYALA RODRIGUEZ, KATHERINE MADAI
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MADAI
Last Name:AYALA RODRIGUEZ
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 1:15243 LARCH ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-4324
Mailing Address - Country:US
Mailing Address - Phone:909-767-3860
Mailing Address - Fax:
Practice Address - Street 1:15243 LARCH ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-4324
Practice Address - Country:US
Practice Address - Phone:909-767-3860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician