Provider Demographics
NPI:1235229931
Name:AYALA ORTA MEDICAL SERVICE PSC
Entity Type:Organization
Organization Name:AYALA ORTA MEDICAL SERVICE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETARIA
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:ORTA
Authorized Official - Last Name:CARDONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-827-2433
Mailing Address - Street 1:PO BOX 6431
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-6431
Mailing Address - Country:US
Mailing Address - Phone:787-827-2433
Mailing Address - Fax:
Practice Address - Street 1:81 AVE MATIAS BRUGMAN
Practice Address - Street 2:
Practice Address - City:LAS MARIAS
Practice Address - State:PR
Practice Address - Zip Code:00670-2008
Practice Address - Country:US
Practice Address - Phone:787-827-2433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10028WOtherMMM
PR2909OtherPMC
PR2909OtherPMC