Provider Demographics
NPI:1528640448
Name:AYALA, JOSE L (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE L
Middle Name:
Last Name:AYALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JOSE L
Other - Middle Name:
Other - Last Name:AYALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:JUANA DIAZ
Mailing Address - State:PR
Mailing Address - Zip Code:00795-1400
Mailing Address - Country:US
Mailing Address - Phone:939-837-2265
Mailing Address - Fax:
Practice Address - Street 1:CDT SAN CRISTOBAL
Practice Address - Street 2:
Practice Address - City:JUANA DIAS
Practice Address - State:PR
Practice Address - Zip Code:00795-1400
Practice Address - Country:US
Practice Address - Phone:787-837-2265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR023570208D00000X
261QM1300X
PR23570208D00000X
PR363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR1528640448OtherGENERAL PRACTITICIONER