Provider Demographics
NPI:1477580983
Name:MENDEZ AYALA, MONICA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:MENDEZ AYALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MONICA
Other - Middle Name:
Other - Last Name:MENDEZ AYALA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:LOS CAMPOS DE MONTEHIEDRA 751 VALLE DEL TOA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-360-2503
Mailing Address - Fax:787-621-3401
Practice Address - Street 1:605 CARR 2 # KM47.7
Practice Address - Street 2:PMB #290 BOX 30500
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-5765
Practice Address - Country:US
Practice Address - Phone:787-621-3400
Practice Address - Fax:787-621-3401
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13157174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22456Medicare ID - Type UnspecifiedMCA
PRI14579Medicare UPIN