Provider Demographics
NPI:1306121215
Name:AYALA, MARTIN
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:
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 1:2011 RAMIREZ LN
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-3977
Mailing Address - Country:US
Mailing Address - Phone:956-624-7470
Mailing Address - Fax:956-548-9677
Practice Address - Street 1:2011 RAMIREZ LN
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78573-3977
Practice Address - Country:US
Practice Address - Phone:956-624-7470
Practice Address - Fax:956-584-9677
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications