Healthcare Provider Details

I. General information

NPI: 1437021698
Provider Name (Legal Business Name): MANUEL AYALA JR. FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 05/31/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 APPALOOSA DR
SUNLAND PARK NM
88063-8904
US

IV. Provider business mailing address

1580 APPALOOSA DR
SUNLAND PARK NM
88063-8904
US

V. Phone/Fax

Practice location:
  • Phone: 575-332-9086
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number87039
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: