Provider Demographics
NPI:1356016752
Name:AYALA, ANDREA Y (SUDRC)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:Y
Last Name:AYALA
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4167 RITA DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-1435
Mailing Address - Country:US
Mailing Address - Phone:925-339-0061
Mailing Address - Fax:
Practice Address - Street 1:2 DAVI AVENUE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-3701
Practice Address - Country:US
Practice Address - Phone:925-427-1384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10053101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)