Healthcare Provider Details

I. General information

NPI: 1790776409
Provider Name (Legal Business Name): ALEJANDRO R AYALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

IV. Provider business mailing address

1400 NW 10TH AVE SUITE 805
MIAMI FL
33136-1000
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-3636
  • Fax: 305-243-6575
Mailing address:
  • Phone: 305-243-3636
  • Fax: 305-243-6575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0058302
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberD0058302
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME96956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: