Provider Demographics
NPI:1245294925
Name:AYALA-CUERVOS, JOSE RAUL SR (MD)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:RAUL
Last Name:AYALA-CUERVOS
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8389
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-8389
Mailing Address - Country:US
Mailing Address - Phone:787-786-4627
Mailing Address - Fax:787-780-6680
Practice Address - Street 1:303 BAYAMON
Practice Address - Street 2:BAYAMON MEDICAL PLAZA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00960
Practice Address - Country:US
Practice Address - Phone:787-786-4627
Practice Address - Fax:787-780-6680
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-12
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR4355207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C77329Medicare UPIN
25453Medicare ID - Type Unspecified