Provider Demographics
NPI:1376747287
Name:CORREA AYALA, ROBERTO F (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:F
Last Name:CORREA 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:POBOX 1085
Mailing Address - Street 2:URB. QUINTAS LAS MUESAS ST .ROBERTO DIAZ AA-13
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00737
Mailing Address - Country:US
Mailing Address - Phone:787-738-2910
Mailing Address - Fax:
Practice Address - Street 1:55 CALLE JOSE CELSO BARBOSA S
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4726
Practice Address - Country:US
Practice Address - Phone:787-738-3088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1524261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local