Provider Demographics
NPI:1598749871
Name:AYALA-MEDINA, JOSE A (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:A
Last Name:AYALA-MEDINA
Suffix:
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:CALLE FELIX DE AZAHARA #1046
Mailing Address - Street 2:COUNTRY CLUB
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00924
Mailing Address - Country:US
Mailing Address - Phone:787-797-9022
Mailing Address - Fax:787-797-9022
Practice Address - Street 1:CT COMERCIAL BELLA VISTA
Practice Address - Street 2:BELLA VISTA # 4
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-0001
Practice Address - Country:US
Practice Address - Phone:787-797-9022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8609208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
0609Other6HP
0082276OtherMCA
P6-3542OtherPALI
1187OtherIHC
8-2276-AYOtherSSS
908609OtherMCS
060260OtherCA
201665OtherUTI
9570010OtherHHP
M-0260OtherCA
201665OtherUTI
F08085Medicare UPIN