Provider Demographics
NPI:1376743518
Name:AYALA, JOSE-RUBEN (MD)
Entity Type:Individual
Prefix:
First Name:JOSE-RUBEN
Middle Name:
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:PO BOX 360557
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15251-6557
Mailing Address - Country:US
Mailing Address - Phone:915-533-6690
Mailing Address - Fax:915-532-3848
Practice Address - Street 1:5401 MONTANA AVE STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4909
Practice Address - Country:US
Practice Address - Phone:915-248-1793
Practice Address - Fax:915-225-3745
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2183352Medicaid
TX2183352Medicaid