Provider Demographics
NPI:1386803765
Name:INSTITUTE OF PLASTIC SURGERY IN SAN ANTONIO, PA
Entity type:Organization
Organization Name:INSTITUTE OF PLASTIC SURGERY IN SAN ANTONIO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:AYALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-692-3223
Mailing Address - Street 1:4499 MEDICAL DRIVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-692-3223
Mailing Address - Fax:
Practice Address - Street 1:4499 MEDICAL DRIVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3713
Practice Address - Country:US
Practice Address - Phone:210-692-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ1851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty