Provider Demographics
NPI:1235322413
Name:AYALA, EDILBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:EDILBERTO
Middle Name:
Last Name:AYALA
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 32278
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-2278
Mailing Address - Country:US
Mailing Address - Phone:787-828-0025
Mailing Address - Fax:787-843-2310
Practice Address - Street 1:HOSPITAL ANDRES GRILLASCA, INC.
Practice Address - Street 2:BO. MACHUELO AVE. TITO CASTRO CARR. 14
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-843-5073
Practice Address - Fax:787-843-2310
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4407174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD48296Medicare PIN