Provider Demographics
NPI:1811204753
Name:AYALA, LISA GAIL
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:GAIL
Last Name:AYALA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:GAIL
Other - Last Name:MAGGIANI-AYALA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5954 COLORVIEW CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-3819
Mailing Address - Country:US
Mailing Address - Phone:408-410-2514
Mailing Address - Fax:
Practice Address - Street 1:1930 CAMDEN AVE STE 2B
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2846
Practice Address - Country:US
Practice Address - Phone:408-410-2514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-13
Last Update Date:2019-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89392106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist