Provider Demographics
NPI:1992367114
Name:AYALA DIAZ, AMBAR JOCELIN
Entity Type:Individual
Prefix:
First Name:AMBAR
Middle Name:JOCELIN
Last Name:AYALA DIAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CAYUGA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-1950
Mailing Address - Country:US
Mailing Address - Phone:716-819-3420
Mailing Address - Fax:
Practice Address - Street 1:301 CAYUGA RD STE 200
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-1950
Practice Address - Country:US
Practice Address - Phone:716-816-3420
Practice Address - Fax:716-819-3430
Is Sole Proprietor?:No
Enumeration Date:2019-07-08
Last Update Date:2019-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator