Provider Demographics
NPI:1881658284
Name:AYALA MARRERO, ALFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:ALFREDO
Middle Name:
Last Name:AYALA MARRERO
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:CAMINO DE LOS COHITRES #102
Mailing Address - Street 2:SABANERA DORADO
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-287-1921
Mailing Address - Fax:787-869-6611
Practice Address - Street 1:AVENIDA DE DIEGO 150
Practice Address - Street 2:SAN JUAN HEALTH CENTRE SUITE 201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-230-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7230208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
28721OtherSSS
400054OtherMMM
7190017OtherHURNMA
M000240OtherH MENONITA
660452859OtherCASUI
17230OtherMCS
2683AOtherPREFERRED MEDICAL OFFICE
M000240OtherH MENONITA
17230OtherMCS
660452859OtherCASUI
PR28721Medicare PIN