Provider Demographics
NPI:1609021708
Name:RODRIGUEZ AYALA, JOSE M
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:M
Last Name:RODRIGUEZ AYALA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:APARTADO 864
Mailing Address - Street 2:
Mailing Address - City:HORMIGUERO
Mailing Address - State:PR
Mailing Address - Zip Code:00660
Mailing Address - Country:US
Mailing Address - Phone:787-849-3208
Mailing Address - Fax:787-849-1440
Practice Address - Street 1:CARRETERA 344 KM 3 0
Practice Address - Street 2:
Practice Address - City:HORMIGUERO
Practice Address - State:PR
Practice Address - Zip Code:00660
Practice Address - Country:US
Practice Address - Phone:787-849-3208
Practice Address - Fax:787-849-1440
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 803416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0059358Medicare PIN