MEDICARE: ALEX JAVIER AYALA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1811541485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEX JAVIER AYALA

Provider Business Mailing Address
First Line	:	8216 MATILIJA AVE
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-5419
Country	:	US
Telephone Number	:	213-842-5215
Fax Number	:

Provider Business Practice Location Address
First Line	:	8216 MATILIJA AVE
Second Line	:
City	:	PANORAMA CITY
State	:	CA
Zip	:	91402-5419
Country	:	US
Telephone Number	:	213-842-5216
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2019
Last Update Date	:	07/31/2019

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