Provider Demographics
NPI:1467679266
Name:GONZALEZ-AYALA, HERMIS IDAMIS
Entity Type:Individual
Prefix:MRS
First Name:HERMIS
Middle Name:IDAMIS
Last Name:GONZALEZ-AYALA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 CALLE CERRO
Mailing Address - Street 2:ALTURAS DE MONTECASINO
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-3741
Mailing Address - Country:US
Mailing Address - Phone:787-251-0365
Mailing Address - Fax:787-779-2369
Practice Address - Street 1:27 CALLE CERRO
Practice Address - Street 2:ALTURAS DE MONTECASINO
Practice Address - City:TOA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00953-3741
Practice Address - Country:US
Practice Address - Phone:787-251-0365
Practice Address - Fax:787-779-2369
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005395183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR118158OtherPHARM. TEC. REGISTER NUM.