Provider Demographics
NPI:1962910356
Name:AYALA VEGA, LIMARIS (MD)
Entity type:Individual
Prefix:
First Name:LIMARIS
Middle Name:
Last Name:AYALA VEGA
Suffix:
Gender:F
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:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:LAS PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00771-1177
Mailing Address - Country:US
Mailing Address - Phone:787-518-7167
Mailing Address - Fax:
Practice Address - Street 1:PREMIER MEDICAL CENTER, BOULEVARD DEL RIO AVE
Practice Address - Street 2:TORRE 3 LOCAL A
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791
Practice Address - Country:US
Practice Address - Phone:787-656-2727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19826208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice