Provider Demographics
NPI:1932385325
Name:AYALA, JESUS A
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:A
Last Name:AYALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MYRTLE CT
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-4790
Mailing Address - Country:US
Mailing Address - Phone:805-382-3074
Mailing Address - Fax:805-382-3077
Practice Address - Street 1:1700 LOMBARD ST
Practice Address - Street 2:SUITE 310
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-8211
Practice Address - Country:US
Practice Address - Phone:805-382-3074
Practice Address - Fax:805-382-3077
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT34352225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist