Provider Demographics
NPI:1134747587
Name:AYALA MORALES, ANGEL M (MD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:M
Last Name:AYALA MORALES
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:PO BOX 2818
Mailing Address - Street 2:
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00785-2818
Mailing Address - Country:US
Mailing Address - Phone:787-378-3468
Mailing Address - Fax:
Practice Address - Street 1:909 AVE TITO CASTRO STE 712
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4722
Practice Address - Country:US
Practice Address - Phone:787-378-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-13
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21879208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty