Provider Demographics
NPI:1841534922
Name:AYALA, MARCO ARTURO (DPT)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:ARTURO
Last Name:AYALA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6131
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:27450 YNEZ RD
Practice Address - Street 2:STE. 120
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4671
Practice Address - Country:US
Practice Address - Phone:951-695-5144
Practice Address - Fax:951-695-9345
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 39628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGU251YMedicare PIN
CAGU251XMedicare PIN