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General NPI Number Information
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NPI Number | 1033545512
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Entity Type | Organization
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Legal Business Name | AYALA ENT & FACIAL PLASTIC SURGERY PLLC
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Dates
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Enumeration Date | 09/17/2013
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Last Update Date | 12/09/2013
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Provider Practice Location Address
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Address Line | 2821 MICHAEL ANGELO STE 201
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City | EDINBURG
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State | TX
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Zip | 78539-1406
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Country | US
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Telephone | 956-631-4515
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Fax | 956-661-8205
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Provider Business Mailing Address
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Address Line | 2821 MICHAEL ANGELO STE 201
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City | EDINBURG
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State | TX
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Zip | 78539-1406
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Country | US
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Telephone | 956-631-4515
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Fax | 956-661-8205
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Authorized Official
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Title or Position | OWNER
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Name | MR. CARLOS AYALA
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Credential | M.D.
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Telephone | 956-631-4515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | P4845
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207YX0007X
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Taxonomy Name | Plastic Surgery within the Head & Neck (Otolaryngology) Physician
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License Number | P4845
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License Number State | TX
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