Provider Demographics
NPI:1205172558
Name:AYALA, ENRIQUE
Entity type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:AYALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7588 PLAZA TAURINA DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-8469
Mailing Address - Country:US
Mailing Address - Phone:915-471-6280
Mailing Address - Fax:
Practice Address - Street 1:7588 PLAZA TAURINA DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-8469
Practice Address - Country:US
Practice Address - Phone:915-471-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-13
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLFOD12-01206172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker