Provider Demographics
NPI:1104072842
Name:AYALA, MIGUEL ANGEL GARCIA (DC)
Entity type:Individual
Prefix:DR
First Name:MIGUEL ANGEL
Middle Name:GARCIA
Last Name:AYALA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:AYALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:705 W LA VETA AVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4402
Mailing Address - Country:US
Mailing Address - Phone:714-288-8886
Mailing Address - Fax:714-288-9054
Practice Address - Street 1:705 W LA VETA AVE
Practice Address - Street 2:SUITE 106
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4402
Practice Address - Country:US
Practice Address - Phone:714-288-8886
Practice Address - Fax:714-288-9054
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC28207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor