Individual
JOSE AYALA-CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1 HARBOR DR STE 300, SAUSALITO, CA 94965-1434
(925) 550-4459
Mailing address
2005 DAVIDSON PL, WHITING, IN 46394-2026
(312) 607-8505
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
95023218
CA
Other
Enumeration date
05/09/2024
Last updated
05/09/2024
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