Basic Information
| Provider Information | |||||||||
| NPI: | 1427684927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYALA | ||||||||
| FirstName: | GABRIEL | ||||||||
| MiddleName: | V | ||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8051 PALOMAS AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871095284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055603645 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8051 PALOMAS AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871095284 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055603645 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2020 | ||||||||
| LastUpdateDate: | 05/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | N | Nursing & Custodial Care Facilities | Skilled Nursing Facility | 235Z00000X | SLP6660 | NM | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.