Provider Demographics
NPI:1891552253
Name:AYALA, ROSA IRIS
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:IRIS
Last Name:AYALA
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 1:1460 MARSHALL ST APT 31
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-6361
Mailing Address - Country:US
Mailing Address - Phone:909-647-7406
Mailing Address - Fax:
Practice Address - Street 1:1460 MARSHALL ST APT 31
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-6361
Practice Address - Country:US
Practice Address - Phone:909-647-7406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1828225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist