Provider Demographics
NPI:1134875669
Name:AYALA, MARCUS RENE (PA-C)
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:RENE
Last Name:AYALA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11212 HIGHWAY 151 STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-4500
Mailing Address - Country:US
Mailing Address - Phone:210-450-9900
Mailing Address - Fax:210-450-9901
Practice Address - Street 1:11212 HIGHWAY 151 STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-4500
Practice Address - Country:US
Practice Address - Phone:210-450-9900
Practice Address - Fax:210-450-9901
Is Sole Proprietor?:No
Enumeration Date:2022-02-23
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA8639363A00000X
TXPA15396363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant