Provider Demographics
NPI:1740678150
Name:AYON, SANDRA J
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:AYON
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 1:950 N RAMONA BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN JACINTO
Mailing Address - State:CA
Mailing Address - Zip Code:92582-2571
Mailing Address - Country:US
Mailing Address - Phone:951-487-2674
Mailing Address - Fax:951-487-2674
Practice Address - Street 1:930 N STATE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-1473
Practice Address - Country:US
Practice Address - Phone:951-765-0917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA235011OtherPARENT PARTNER
CA235011OtherCLINICAL THERAPIST I
CA1740678150OtherMENTAL HEALTH PROGRAM COORDINATOR