Provider Demographics
NPI:1992939326
Name:AYALA, JOSE J (LSA)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:J
Last Name:AYALA
Suffix:
Gender:M
Credentials:LSA
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Mailing Address - Street 1:13203 PARK MANOR ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1530
Mailing Address - Country:US
Mailing Address - Phone:210-414-6626
Mailing Address - Fax:210-468-2834
Practice Address - Street 1:13203 PARK MANOR ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1530
Practice Address - Country:US
Practice Address - Phone:210-414-6626
Practice Address - Fax:210-468-2834
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2015-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXSA00397363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical