Provider Demographics
NPI:1922725282
Name:AYALA, TYLER CRAIG
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:CRAIG
Last Name:AYALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2935 4TH ST
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-3222
Mailing Address - Country:US
Mailing Address - Phone:209-531-2088
Mailing Address - Fax:
Practice Address - Street 1:2528 LESLIE LN
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-2326
Practice Address - Country:US
Practice Address - Phone:209-538-7331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health