Healthcare Provider Details

I. General information

NPI: 1427218767
Provider Name (Legal Business Name): JOAN AYALA RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

007 CHOOSGAI DRIVE
TOHATCHI NM
87325
US

IV. Provider business mailing address

P.O. BOX 1337
GALLUP NM
87305-1337
US

V. Phone/Fax

Practice location:
  • Phone: 505-733-8400
  • Fax:
Mailing address:
  • Phone: 505-722-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number025433
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number025433
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: