Provider Demographics
NPI:1508993072
Name:AYALA, ROSALYN YANIRA
Entity Type:Individual
Prefix:MISS
First Name:ROSALYN
Middle Name:YANIRA
Last Name: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:CALLE 1 URB. SYLVIA
Mailing Address - Street 2:C 18
Mailing Address - City:COROZAL
Mailing Address - State:PR
Mailing Address - Zip Code:00783
Mailing Address - Country:US
Mailing Address - Phone:787-409-5189
Mailing Address - Fax:787-859-4969
Practice Address - Street 1:1 C
Practice Address - Street 2:URB. SYLVIA C 18
Practice Address - City:COROZAL
Practice Address - State:PR
Practice Address - Zip Code:00783
Practice Address - Country:US
Practice Address - Phone:787-409-5189
Practice Address - Fax:787-859-4969
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5369183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician