Healthcare Provider Details

I. General information

NPI: 1164556882
Provider Name (Legal Business Name): RAUL AYALA MD P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10508 GIBSONTON DR
RIVERVIEW FL
33569-5434
US

IV. Provider business mailing address

10508 GIBSONTON DR
RIVERVIEW FL
33569-5434
US

V. Phone/Fax

Practice location:
  • Phone: 813-741-2100
  • Fax: 813-741-2003
Mailing address:
  • Phone: 813-741-2100
  • Fax: 813-741-2003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. GABRIELA P ACOSTA
Title or Position: OFFICE MANAGER
Credential:
Phone: 813-741-2100