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General NPI Number Information
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NPI Number | 1154440436
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Entity Type | Organization
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Legal Business Name | RAUL AYALA MD P.A.
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10508 GIBSONTON DR
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City | RIVERVIEW
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State | FL
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Zip | 33569-5434
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Country | US
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Telephone | 813-741-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 10508 GIBSONTON DR
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City | RIVERVIEW
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State | FL
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Zip | 33569-5434
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Country | US
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Telephone | 813-741-2100
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Fax | 813-741-2100
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. GABRIELA P ACOSTA
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Credential |
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Telephone | 813-741-2100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME79510
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License Number State | FL
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