Basic Information
| Provider Information | |||||||||
| NPI: | 1558472415 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AYALA | ||||||||
| FirstName: | MILTON | ||||||||
| MiddleName: | RAFAEL | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8719 REDWOOD BND | ||||||||
| Address2: | |||||||||
| City: | HELOTES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780234488 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106175113 | ||||||||
| FaxNumber: | 2109493326 | ||||||||
| Practice Location | |||||||||
| Address1: | 7400 MERTON MINTER ST | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782294404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106175113 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 18929 | TX | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.