Provider Demographics
NPI:1760466023
Name:AYALA-COLON, JORGE LUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:LUIS
Last Name:AYALA-COLON
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:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:SABANA GRANDE
Mailing Address - State:PR
Mailing Address - Zip Code:00637-0409
Mailing Address - Country:US
Mailing Address - Phone:787-873-1115
Mailing Address - Fax:787-804-0292
Practice Address - Street 1:6 CALLE FRANCISCO M QUINONEZ
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1945
Practice Address - Country:US
Practice Address - Phone:787-873-0440
Practice Address - Fax:787-804-0292
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8585OtherSTATE LICENSE
PR8585OtherSTATE LICENSE
PRE67670Medicare UPIN