Provider Demographics
NPI:1427684927
Name:AYALA, GABRIEL V (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:V
Last Name:AYALA
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8051 PALOMAS AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-5284
Mailing Address - Country:US
Mailing Address - Phone:505-560-3645
Mailing Address - Fax:
Practice Address - Street 1:8051 PALOMAS AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-5284
Practice Address - Country:US
Practice Address - Phone:505-560-3645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
314000000X
NMSLP6660235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility