Provider Demographics
NPI:1205968807
Name:LUIS A AYALA, M.D.
Entity type:Organization
Organization Name:LUIS A AYALA, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:CCMA-AC, ASBA
Authorized Official - Phone:559-583-9100
Mailing Address - Street 1:1250 N IRWIN ST
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-2956
Mailing Address - Country:US
Mailing Address - Phone:559-583-9100
Mailing Address - Fax:559-583-0925
Practice Address - Street 1:1250 N IRWIN ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-2956
Practice Address - Country:US
Practice Address - Phone:559-583-9100
Practice Address - Fax:559-583-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA060697174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG47684Medicare UPIN