Provider Demographics
NPI:1861456345
Name:RODRIGUEZ AYALA, HERIBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:HERIBERTO
Middle Name:
Last Name:RODRIGUEZ AYALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HERIBERTO
Other - Middle Name:
Other - Last Name:RODRIGUEZ AYALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5419 S MCCOLL RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-9183
Mailing Address - Country:US
Mailing Address - Phone:956-928-0600
Mailing Address - Fax:877-582-6921
Practice Address - Street 1:5419 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-9183
Practice Address - Country:US
Practice Address - Phone:956-928-0600
Practice Address - Fax:877-582-6921
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0247207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CG085OtherBC/BS TEXAS
TX170275503Medicaid
TX2090516-01Medicaid