Provider Demographics
NPI:1124189352
Name:AYALA CRUZ, PEDRO N (MD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:N
Last Name:AYALA CRUZ
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:PO BOX 3267
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-3267
Mailing Address - Country:US
Mailing Address - Phone:787-892-1860
Mailing Address - Fax:
Practice Address - Street 1:4 CALLE TETUAN
Practice Address - Street 2:
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683-4088
Practice Address - Country:US
Practice Address - Phone:787-892-5811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14908207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR14908OtherSTATE LICENCE
PR0023232Medicaid
PRDM-14949-2OtherSTATE NARCOTIC LICENCE
PRDEA-BA8575081OtherFEDERAL NARCOTIC LICENCE
PR0023232Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRDM-14949-2OtherSTATE NARCOTIC LICENCE