Active NPI
Eliseo Ayala, PA C
- Physician Assistant
- South Gate, CA
National Provider Identifier
1992812283
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA17268
- Practice address
- 8225 Long Beach Blvd
South Gate, CA 90280 - Phone
- (323) 585-1056
- Fax
- (323) 587-1671
- NPI assigned
- Aug 24, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA17268 | CA | Primary |
Addresses
Primary practice location
8225 Long Beach Blvd
South Gate, CA 90280
Mailing address
6127 Fishburn Ave
Huntington Park, CA 90255
Phone (323) 771-4689
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17268 | CA | MD | Professional Counselor |
| PA17268 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| La Libertad Medical Clinic Inc | Past | Accepting new patients | |
| La Libertad Medical Clinic Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Physician
- South Gate, CA
- NPI 1073791828
-
- General Practice Physician
- South Gate, CA
- NPI 1295887024
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992812283",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6127 FISHBURN AVE",
"city": "HUNTINGTON PARK",
"state": "CA",
"postal_code": "90255",
"telephone_number": "323-771-4689",
"fax_number": "323-771-4689"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8225 LONG BEACH BLVD",
"city": "SOUTH GATE",
"state": "CA",
"postal_code": "90280",
"telephone_number": "323-585-1056",
"fax_number": "323-587-1671"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AYALA",
"first_name": "ELISEO",
"credential": "PA C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-24",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA17268",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Gate, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.