| Patient | Michelle Ayala | Preferred Language | en |
| Date of birth | January 30, 1985 | Sex | Female |
| Race | Unspecified
|
Ethnicity | Unspecified |
| Contact info | Home:
2225 S Western Ave Chicago, IL 60608, US Tel (Mobile): +1(708)-642-4353 Tel (Primary Home): +1(708)-642-4353 Mail: mayala_1985@yahoo.com |
Patient IDs | 2711459 2.16.840.1.113883.3.3710.999.44.88800115636.7770000101
MM0000000854 2.16.840.1.113883.3.3710.3 MODMED 2.16.840.1.113883.3.3710.200.501 115636PAT000000863 2.16.840.1.113883.3.3710.200.500 |
| Document Id | test-id-633705435 2.16.840.1.113883.3.3710.0 |
| Document Created: | April 7, 2024, 07:10:03 +0000 |
| Author | Diana Tagaban, Jaime S. Schwartz, MD |
| Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |
| Encounter Id | |||
| Encounter Date | From , to , | ||
| Encounter Participant | |||
| Contact info |
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| Legal authenticator | Diana Tagaban signed at April 7, 2024, 07:10:03 +0000 |
| Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |
| Document maintained by | Jaime S. Schwartz, MD |
| Contact info | Work Place:
240 S La Cienega Blvd Ste 200 Beverly Hills, CA 902113324, US Tel (Work Place): 3108825454 |