Provider Demographics
NPI:1174101372
Name:AYALA, ROBERTINA SANCHEZ I (LVN)
Entity type:Individual
Prefix:
First Name:ROBERTINA
Middle Name:SANCHEZ
Last Name:AYALA
Suffix:I
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 1:7940 TOPANGA CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-4732
Mailing Address - Country:US
Mailing Address - Phone:800-582-0709
Mailing Address - Fax:
Practice Address - Street 1:7940 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-4732
Practice Address - Country:US
Practice Address - Phone:800-582-0709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN290594164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse