Provider Demographics
NPI:1427407642
Name:AYLLON, MARIELLA ISABEL
Entity Type:Individual
Prefix:
First Name:MARIELLA
Middle Name:ISABEL
Last Name:AYLLON
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 1:1202 W CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-2252
Mailing Address - Country:US
Mailing Address - Phone:714-791-4446
Mailing Address - Fax:714-245-0047
Practice Address - Street 1:1202 W CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-2252
Practice Address - Country:US
Practice Address - Phone:714-791-4446
Practice Address - Fax:714-245-0047
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker