Provider Demographics
NPI:1669837589
Name:LOPEZ AYALA, NOELYS MARIE (73868)
Entity Type:Individual
Prefix:
First Name:NOELYS
Middle Name:MARIE
Last Name:LOPEZ AYALA
Suffix:
Gender:F
Credentials:73868
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 CALLE NICOLAS SOTO RAMOS
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-2714
Mailing Address - Country:US
Mailing Address - Phone:787-710-2532
Mailing Address - Fax:787-986-7614
Practice Address - Street 1:AVENIDA HOSTOS CARR 2 K.M 156.5
Practice Address - Street 2:OFFICE PARK 4 BUILDING ST. RODE 349 SUITE
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-1511
Practice Address - Country:US
Practice Address - Phone:787-710-2532
Practice Address - Fax:787-986-7614
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR73868163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR73868OtherNURSE LICENSE