Provider Demographics
NPI:1770085235
Name:AYALA, HEATHER M (RD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:M
Last Name:AYALA
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25552 DARTMOUTH CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5009
Mailing Address - Country:US
Mailing Address - Phone:714-421-6407
Mailing Address - Fax:
Practice Address - Street 1:25552 DARTMOUTH CIR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-5009
Practice Address - Country:US
Practice Address - Phone:714-421-6407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered