Individual
MR. JACK ANTHONY AYALA I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1225 4TH ST NW, ALBUQUERQUE, NM 87102-1414
(505) 212-7363
Mailing address
1225 4TH ST NW, ALBUQUERQUE, NM 87102-1414
(505) 212-7363
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/02/2010
Last updated
11/02/2010
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