Provider Demographics
NPI:1427096734
Name:AYALA, JOSE LUIS (DPM)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:AYALA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 N EXPRESSWAY
Mailing Address - Street 2:SUITE 305B
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-4353
Mailing Address - Country:US
Mailing Address - Phone:956-504-1469
Mailing Address - Fax:956-504-9270
Practice Address - Street 1:5700 N EXPRESSWAY
Practice Address - Street 2:SUITE 305B
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-4353
Practice Address - Country:US
Practice Address - Phone:956-504-1469
Practice Address - Fax:956-504-9270
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2008-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1303213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092855804Medicaid
U55171Medicare UPIN
TX092855804Medicaid