Basic Information
Provider Information
NPI: 1003152232
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AYALA
FirstName: CELINA
MiddleName: MARIE
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8080 PARK MEADOWS DR.
Address2:  
City: LONE TREE
State: CO
PostalCode: 801242558
CountryCode: US
TelephoneNumber: 3033468828
FaxNumber: 3033460407
Practice Location
Address1: 8080 PARK MEADOWS DR.
Address2:  
City: LONETREE
State: CO
PostalCode: 801242558
CountryCode: US
TelephoneNumber: 7204939006
FaxNumber: 8007339406
Other Information
ProviderEnumerationDate: 12/16/2012
LastUpdateDate: 10/14/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363AM0700X3465COY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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