Healthcare Provider Details

I. General information

NPI: 1255289575
Provider Name (Legal Business Name): JAMES AJALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2026
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 W BARBARA WORTH DR
EL CENTRO CA
92243-2133
US

IV. Provider business mailing address

1507 W BARBARA WORTH DR APT 62
EL CENTRO CA
92243-2132
US

V. Phone/Fax

Practice location:
  • Phone: 623-200-2261
  • Fax:
Mailing address:
  • Phone: 623-200-2261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number91598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: