Provider Demographics
NPI:1922019207
Name:AYALA, RINA P (MD)
Entity Type:Individual
Prefix:DR
First Name:RINA
Middle Name:P
Last Name:AYALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10208 NW 125TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6013
Mailing Address - Country:US
Mailing Address - Phone:786-501-4612
Mailing Address - Fax:
Practice Address - Street 1:10208 NW 125TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-6013
Practice Address - Country:US
Practice Address - Phone:786-501-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0020484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053548600Medicaid
FL053548600Medicaid
FLD59797Medicare UPIN