Provider Demographics
NPI:1417996919
Name:AYALA CARDONA, HEIDI MELISSA (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MELISSA
Last Name:AYALA CARDONA
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:PO BOX 2300
Mailing Address - Street 2:PMB # 21
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-2300
Mailing Address - Country:US
Mailing Address - Phone:939-642-2033
Mailing Address - Fax:
Practice Address - Street 1:EDIFICIO PROFESIONAL OFICINA 202 HOSPITAL MENONITA
Practice Address - Street 2:CALLE JOSE C VAZQUEZ
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-7110
Practice Address - Fax:787-991-3041
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13948207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI16322Medicare UPIN
PR22590Medicare ID - Type Unspecified