Healthcare Provider Details

I. General information

NPI: 1053669077
Provider Name (Legal Business Name): DIANA M AYALA D.D.S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2012
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 ALAVA AVE
CORAL GABLES FL
33146-1217
US

IV. Provider business mailing address

921 ALAVA AVE
CORAL GABLES FL
33146-1217
US

V. Phone/Fax

Practice location:
  • Phone: 786-439-9906
  • Fax:
Mailing address:
  • Phone: 786-439-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN 19902
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: