Provider Demographics
NPI:1255317921
Name:AYALA, ISRAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ISRAEL
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 1:20 CALLE GLORIMAR
Mailing Address - Street 2:JARDINES CALDAS RIO PIEDRAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5316
Mailing Address - Country:US
Mailing Address - Phone:787-385-6740
Mailing Address - Fax:787-251-4518
Practice Address - Street 1:ADMINISTRACION DE SERVICIOS MEDICOS
Practice Address - Street 2:BOX 2129
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-777-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5546207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC77451Medicare UPIN