Provider Demographics
NPI:1578867743
Name:JESSICA COREEN AYALA
Entity Type:Organization
Organization Name:JESSICA COREEN AYALA
Other - Org Name:HALO REHABILITATION SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:COREEN
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-402-7827
Mailing Address - Street 1:3441 YORKMINSTER ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-8906
Mailing Address - Country:US
Mailing Address - Phone:916-402-7827
Mailing Address - Fax:
Practice Address - Street 1:3441 YORKMINSTER ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-8906
Practice Address - Country:US
Practice Address - Phone:916-402-7827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health