Provider Demographics
NPI:1679662522
Name:AYALA, BRUNILDA (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:BRUNILDA
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P . O. 8368
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8368
Mailing Address - Country:US
Mailing Address - Phone:787-795-5131
Mailing Address - Fax:
Practice Address - Street 1:STA. CRUZ ST. B-7
Practice Address - Street 2:GRUPO MEDICO SAN PABLO BLDG
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-780-9316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician