Provider Demographics
NPI:1649727041
Name:AYALA, RACHEL (MSC, RD, LD)
Entity type:Individual
Prefix:MISS
First Name:RACHEL
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:MSC, RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6361 SCHOOL ST SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1318
Mailing Address - Country:US
Mailing Address - Phone:903-262-6546
Mailing Address - Fax:
Practice Address - Street 1:2811 NW HILLTOP DR
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507
Practice Address - Country:US
Practice Address - Phone:903-262-6546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-02
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT85143133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered