Provider Demographics
NPI:1538490206
Name:HERIBERTO RODRIGUEZ-AYALA MD PA
Entity Type:Organization
Organization Name:HERIBERTO RODRIGUEZ-AYALA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HERIBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ-AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-928-0600
Mailing Address - Street 1:PO BOX 4486
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4486
Mailing Address - Country:US
Mailing Address - Phone:956-928-0600
Mailing Address - Fax:
Practice Address - Street 1:5419 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9183
Practice Address - Country:US
Practice Address - Phone:956-928-0600
Practice Address - Fax:877-582-6921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0247174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209051601Medicaid