Provider Demographics
NPI:1396980892
Name:DE AYALA, HUGO (MD)
Entity type:Individual
Prefix:DR
First Name:HUGO
Middle Name:
Last Name:DE AYALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7900
Mailing Address - Country:US
Mailing Address - Phone:954-983-8186
Mailing Address - Fax:954-983-9093
Practice Address - Street 1:6100 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-7900
Practice Address - Country:US
Practice Address - Phone:954-983-8186
Practice Address - Fax:954-983-9093
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL48449174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD84722Medicare UPIN