Provider Demographics
NPI:1679163968
Name:AYALA-SANCHEZ, JALEESAH N
Entity type:Individual
Prefix:
First Name:JALEESAH
Middle Name:N
Last Name:AYALA-SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1215 HEATHER OAKS WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-1507
Mailing Address - Country:US
Mailing Address - Phone:702-354-0143
Mailing Address - Fax:
Practice Address - Street 1:1215 HEATHER OAKS WAY
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-1507
Practice Address - Country:US
Practice Address - Phone:702-354-0144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist