Provider Demographics
NPI:1265558712
Name:AYALA, MAYRA I (CPHT)
Entity type:Individual
Prefix:MS
First Name:MAYRA
Middle Name:I
Last Name:AYALA
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:I13 CALLE 11
Mailing Address - Street 2:URB. CONDADO MODERNO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2437
Mailing Address - Country:US
Mailing Address - Phone:787-469-7500
Mailing Address - Fax:
Practice Address - Street 1:I13 CALLE 11
Practice Address - Street 2:URB. CONDADO MODERNO
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725-2437
Practice Address - Country:US
Practice Address - Phone:787-469-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001577183700000X
WA270101031153720183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician