Healthcare Provider Details

I. General information

NPI: 1588580104
Provider Name (Legal Business Name): CAROLINA CAZARES AYALA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 3 #550
AUA PRIETA SONORA
84210
MX

IV. Provider business mailing address

601 E 10TH ST # 286
DOUGLAS AZ
85607-2038
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. CAROLINA CAZARES AYALA
Title or Position: DENTIST
Credential: DDS
Phone: 619-272-9025