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NPI Code Detail

MEDICARE: RAVEN AYALA

MEDICARE: RAVEN AYALA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1225423585
Entity Type Code : Individual
Provider Name (Legal Business Name) : RAVEN AYALA
Provider Business Mailing Address
First Line : 502 E RACE AVE
Second Line :
City : SEARCY
State : AR
Zip : 72143-4417
Country : US
Telephone Number : 501-729-6300
Fax Number :
Provider Business Practice Location Address
First Line : 502 E RACE AVE
Second Line :
City : SEARCY
State : AR
Zip : 72143-4417
Country : US
Telephone Number : 501-729-6300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2015
Last Update Date : 04/03/2015

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Directions to “ RAVEN AYALA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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