Provider Demographics
NPI:1245585199
Name:VICTOR AYALA MD PA
Entity Type:Organization
Organization Name:VICTOR AYALA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-452-0774
Mailing Address - Street 1:220 SW 84TH AVE
Mailing Address - Street 2:SUITE #106
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2754
Mailing Address - Country:US
Mailing Address - Phone:954-452-0774
Mailing Address - Fax:
Practice Address - Street 1:220 SW 84TH AVE
Practice Address - Street 2:SUITE #106
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2754
Practice Address - Country:US
Practice Address - Phone:954-452-0774
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0055215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty