Provider Demographics
NPI:1881688174
Name:AYALA, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
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 1:800 E DOVE AVE
Mailing Address - Street 2:STE F & G
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2262
Mailing Address - Country:US
Mailing Address - Phone:956-631-4515
Mailing Address - Fax:956-627-6071
Practice Address - Street 1:800 E DOVE AVE
Practice Address - Street 2:STE F AND G
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2262
Practice Address - Country:US
Practice Address - Phone:956-631-4515
Practice Address - Fax:956-661-8205
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208769207YX0905X
TXP4845207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX279088YZWEMedicare PIN