Provider Demographics
NPI:1386184349
Name:AYALA, CARLA (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2A4 URB ESTANCIAS DE CERRO GORDO
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00957
Mailing Address - Country:US
Mailing Address - Phone:787-672-2494
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE 4 # A
Practice Address - Street 2:URB.ESTANCIAS DE CERRO GORDO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00957-6919
Practice Address - Country:US
Practice Address - Phone:787-672-2494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14346390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program