Provider Demographics
NPI:1568585461
Name:AYALA-COSME, EILEEN
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:
Last Name:AYALA-COSME
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:T1 CALLE 1A
Mailing Address - Street 2:REPTO. VALENCIA, HATO TEJAS
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-3732
Mailing Address - Country:US
Mailing Address - Phone:787-740-7873
Mailing Address - Fax:
Practice Address - Street 1:T1 CALLE 1A
Practice Address - Street 2:REPTO. VALENCIA, HATO TEJAS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-3732
Practice Address - Country:US
Practice Address - Phone:787-740-7873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice