Provider Demographics
NPI:1972034627
Name:AYALA, AXEL (BOCP-C49908,CFO01527)
Entity Type:Individual
Prefix:MR
First Name:AXEL
Middle Name:
Last Name:AYALA
Suffix:
Gender:M
Credentials:BOCP-C49908,CFO01527
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:I8 URB EL MADRIGAL MARGINAL NORTE
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00730-1469
Mailing Address - Country:US
Mailing Address - Phone:787-900-5718
Mailing Address - Fax:
Practice Address - Street 1:I8 URB EL MADRIGAL MARGINAL NORTE
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00730-1469
Practice Address - Country:US
Practice Address - Phone:787-900-5718
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRBOCPC499081744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management