Provider Demographics
NPI:1003457474
Name:SZMURLO, AYLA NICOLE (PA)
Entity type:Individual
Prefix:
First Name:AYLA
Middle Name:NICOLE
Last Name:SZMURLO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AYLA
Other - Middle Name:NICOLE
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5089
Mailing Address - Street 2:
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-8003
Mailing Address - Country:US
Mailing Address - Phone:951-808-6240
Mailing Address - Fax:951-738-9954
Practice Address - Street 1:2250 S MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2538
Practice Address - Country:US
Practice Address - Phone:951-737-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-07
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57315363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical