Provider Demographics
NPI:1538102264
Name:AYALA, JOSE ANTONIO SR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:AYALA
Suffix:SR
Gender:M
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:#100 PASEO SAN PABLO OFICINA 204
Mailing Address - Street 2:HOSPITAL SAN PABLO EDIFICIO ARTURO CADILLA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7019
Mailing Address - Country:US
Mailing Address - Phone:787-740-2925
Mailing Address - Fax:787-786-4667
Practice Address - Street 1:100 PASEO SAN PABLO
Practice Address - Street 2:HOSPITAL SAN PABLO EDIFICIO ARTURO CADILLA 204
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7019
Practice Address - Country:US
Practice Address - Phone:787-740-2925
Practice Address - Fax:787-786-4667
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0029762Medicare PIN
PRD32362Medicare UPIN