Provider Demographics
NPI:1881619096
Name:AYALA, REBECA (MD)
Entity type:Individual
Prefix:DR
First Name:REBECA
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REBECA
Other - Middle Name:
Other - Last Name:ROSADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:140 ACADEMY ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-3102
Mailing Address - Country:US
Mailing Address - Phone:207-764-5437
Mailing Address - Fax:207-764-4760
Practice Address - Street 1:140 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-3102
Practice Address - Country:US
Practice Address - Phone:207-764-5437
Practice Address - Fax:207-764-4760
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD15278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1881619096Medicaid
MEMD974901Medicare PIN