Provider Demographics
NPI:1053895888
Name:AYALA, SERGIO GABRIEL
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:GABRIEL
Last Name:AYALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 SENECA DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-9111
Mailing Address - Country:US
Mailing Address - Phone:209-968-0574
Mailing Address - Fax:
Practice Address - Street 1:300 LOS ALTOS PKWY STE 109
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-7754
Practice Address - Country:US
Practice Address - Phone:775-996-3890
Practice Address - Fax:844-402-8510
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician