Provider Demographics
NPI:1326012303
Name:AYALA, RUBEN JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:JAVIER
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 1:14283 SW 42 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175
Mailing Address - Country:US
Mailing Address - Phone:305-226-1001
Mailing Address - Fax:305-485-5529
Practice Address - Street 1:14283 SW 42 ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175
Practice Address - Country:US
Practice Address - Phone:305-226-1001
Practice Address - Fax:305-485-5529
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI15214Medicare UPIN
FLK8540Medicare ID - Type Unspecified