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General NPI Number Information
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NPI Number | 1962769539
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Entity Type | Organization
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Legal Business Name | AYALA MEDICAL CORPORATION INC
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 04/05/2013
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Provider Practice Location Address
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Address Line | 1490 DEL MAR BLVD
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City | PASADENA
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State | CA
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Zip | 91106-2704
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Country | US
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Telephone | 626-375-7435
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Fax |
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Provider Business Mailing Address
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Address Line | 1490 E DEL MAR BLVD
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City | PASADENA
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State | CA
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Zip | 91106-2704
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Country | US
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Telephone | 626-375-7435
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA VIRGINIA G SIOSON AYALA
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Credential | MD
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Telephone | 626-375-7435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A105436
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License Number State | CA
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