Provider Demographics
NPI:1407699325
Name:AYALA MOJICA, ZUANETLEY R
Entity type:Individual
Prefix:
First Name:ZUANETLEY
Middle Name:R
Last Name:AYALA MOJICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 AVE CHARDON
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1747
Mailing Address - Country:US
Mailing Address - Phone:787-922-1270
Mailing Address - Fax:
Practice Address - Street 1:159 AVE CHARDON
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1747
Practice Address - Country:US
Practice Address - Phone:787-922-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13120104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker