Provider Demographics
NPI:1780311977
Name:AYALA RAMOS, PAUL GIOVANNI (NEMT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:GIOVANNI
Last Name:AYALA RAMOS
Suffix:
Gender:M
Credentials:NEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 S 3RD W APT 1
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:ID
Mailing Address - Zip Code:83647-3447
Mailing Address - Country:US
Mailing Address - Phone:208-598-1004
Mailing Address - Fax:
Practice Address - Street 1:1195 S 3RD W APT 1
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:ID
Practice Address - Zip Code:83647-3447
Practice Address - Country:US
Practice Address - Phone:208-598-1004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAD009236C172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty