Provider Demographics
NPI:1477857688
Name:MAYORAL, AIXA SORAYA
Entity Type:Individual
Prefix:MRS
First Name:AIXA
Middle Name:SORAYA
Last Name:MAYORAL
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 1:26 CALLE C
Mailing Address - Street 2:URB. PARQUE LAS AMERICAS
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1111
Mailing Address - Country:US
Mailing Address - Phone:787-479-6351
Mailing Address - Fax:
Practice Address - Street 1:1305 AVE MAGDALENA APT 503
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1913
Practice Address - Country:US
Practice Address - Phone:787-479-6351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7848183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician