Provider Demographics
NPI:1154440436
Name:RAUL AYALA MD P.A.
Entity Type:Organization
Organization Name:RAUL AYALA MD P.A.
Other - Org Name:BOYETTE WALK IN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GABRIELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-741-2100
Mailing Address - Street 1:10508 GIBSONTON DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5434
Mailing Address - Country:US
Mailing Address - Phone:813-741-2100
Mailing Address - Fax:813-741-2100
Practice Address - Street 1:10508 GIBSONTON DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5434
Practice Address - Country:US
Practice Address - Phone:813-741-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1055495OtherCARE PLUS ID #
FL=========COtherHUMANA UC ID#
FLE5532Medicare ID - Type Unspecified
FL=========COtherHUMANA UC ID#