Provider Demographics
NPI:1346519782
Name:AYALA ARIZMENDI, MARCELA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARCELA
Middle Name:
Last Name:AYALA ARIZMENDI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1817 W NEIGHBORS AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2781
Mailing Address - Country:US
Mailing Address - Phone:916-718-6655
Mailing Address - Fax:
Practice Address - Street 1:1719 W RPMNEYA DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-991-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61047122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1223G0001XOtherHEALTH CARE PROVIDER TAXONOMY CODE SET