Provider Demographics
NPI:1225221765
Name:RAYALA, JADE PORCIUNCULA (MD)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:PORCIUNCULA
Last Name:RAYALA
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5317 HIGHGATE DR
Mailing Address - Street 2:SUITE 117
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6622
Mailing Address - Country:US
Mailing Address - Phone:919-361-2644
Mailing Address - Fax:919-484-0849
Practice Address - Street 1:5317 HIGHGATE DR
Practice Address - Street 2:SUITE 117
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6622
Practice Address - Country:US
Practice Address - Phone:919-361-2644
Practice Address - Fax:919-484-0849
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-18
Last Update Date:2012-07-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301090285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine