Provider Demographics
NPI:1033353313
Name:AYALA, ORVIL LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ORVIL
Middle Name:LUIS
Last Name:AYALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3433 LITHIA PINECREST RD STE 196
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-6302
Mailing Address - Country:US
Mailing Address - Phone:813-938-6627
Mailing Address - Fax:
Practice Address - Street 1:342 E BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8155
Practice Address - Country:US
Practice Address - Phone:813-938-6627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.121076207L00000X, 207LP2900X, 208VP0000X, 208VP0014X, 208VP0014X
FLME115422207LP2900X, 208VP0000X, 208VP0014X, 207L00000X, 208VP0014X, 207L00000X
NJ25MA09596800208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0156527Medicaid
OHH371090Medicare PIN
FLHU015ZMedicare PIN