Provider Demographics
NPI:1609109834
Name:AYALA, IRIS NEREIDA (MD, FACOG)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:NEREIDA
Last Name:AYALA
Suffix:
Gender:F
Credentials:MD, FACOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 WEST WOODWARD AVENE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726
Mailing Address - Country:US
Mailing Address - Phone:352-483-3730
Mailing Address - Fax:352-483-3355
Practice Address - Street 1:400 W WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-4555
Practice Address - Country:US
Practice Address - Phone:352-483-3730
Practice Address - Fax:352-483-3355
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94062207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5301301Medicaid
NJAY726166Medicare UPIN