Provider Demographics
NPI:1972740462
Name:IVAN L AYALA MD PA
Entity Type:Organization
Organization Name:IVAN L AYALA MD PA
Other - Org Name:ATLANTIC COAST RADIOLOGY, SF
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-318-2090
Mailing Address - Street 1:220 SW 84TH AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2729
Mailing Address - Country:US
Mailing Address - Phone:954-452-0774
Mailing Address - Fax:
Practice Address - Street 1:220 SW 84TH AVE STE 106
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2729
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:2009-01-21
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD61077Medicare UPIN