Provider Demographics
NPI:1780916163
Name:AYALA, SERGIO (DDS)
Entity type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:
Last Name:AYALA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 LESLIE RD
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6285
Mailing Address - Country:US
Mailing Address - Phone:161-951-9361
Mailing Address - Fax:
Practice Address - Street 1:706 TOWNSITE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-4502
Practice Address - Country:US
Practice Address - Phone:760-724-4392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA589371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice