Provider Demographics
NPI:1720323637
Name:AYALA, LORALEI (LVN)
Entity Type:Individual
Prefix:
First Name:LORALEI
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 22ND AVE APT F8
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-4800
Mailing Address - Country:US
Mailing Address - Phone:661-709-5065
Mailing Address - Fax:
Practice Address - Street 1:29325 KIMBERLINA RD
Practice Address - Street 2:
Practice Address - City:WASCO
Practice Address - State:CA
Practice Address - Zip Code:93280
Practice Address - Country:US
Practice Address - Phone:661-758-4029
Practice Address - Fax:661-758-0891
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-04
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA268943164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse