Provider Demographics
NPI:1982824223
Name:AYALA, JULISSA (LPN)
Entity Type:Individual
Prefix:MRS
First Name:JULISSA
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. SANTIAGO
Mailing Address - Street 2:CALLE B BUZON 65
Mailing Address - City:LOIZA
Mailing Address - State:PR
Mailing Address - Zip Code:00772
Mailing Address - Country:US
Mailing Address - Phone:787-763-7521
Mailing Address - Fax:787-763-2480
Practice Address - Street 1:MEDIANIA BAJA
Practice Address - Street 2:LA 23
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-763-7521
Practice Address - Fax:787-763-2480
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28727164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse