Healthcare Provider Details

I. General information

NPI: 1427684927
Provider Name (Legal Business Name): GABRIEL V AYALA MS, CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2020
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 PALOMAS AVE NE
ALBUQUERQUE NM
87109-5284
US

IV. Provider business mailing address

8051 PALOMAS AVE NE
ALBUQUERQUE NM
87109-5284
US

V. Phone/Fax

Practice location:
  • Phone: 505-560-3645
  • Fax:
Mailing address:
  • Phone: 505-560-3645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSLP6660
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: