Provider Demographics
NPI:1255802377
Name:AYE, MALLORY KATHRYN (NMD)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:KATHRYN
Last Name:AYE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:DR
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:AYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NMD
Mailing Address - Street 1:2322 ALTA ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-2846
Mailing Address - Country:US
Mailing Address - Phone:971-322-8682
Mailing Address - Fax:
Practice Address - Street 1:1021 E WALNUT ST STE 100
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1478
Practice Address - Country:US
Practice Address - Phone:323-207-5953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4219175F00000X
AZ18-1760175F00000X
CA1135175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath