Provider Demographics
NPI:1942466214
Name:LUIS A AYALA, M.D., INC.
Entity Type:Organization
Organization Name:LUIS A AYALA, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-368-8583
Mailing Address - Street 1:801 BREWSTER AVE
Mailing Address - Street 2:250
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1557
Mailing Address - Country:US
Mailing Address - Phone:650-368-8583
Mailing Address - Fax:650-361-8396
Practice Address - Street 1:801 BREWSTER AVE
Practice Address - Street 2:250
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1557
Practice Address - Country:US
Practice Address - Phone:650-368-8583
Practice Address - Fax:650-361-8396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA060697261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG47684Medicare UPIN