Healthcare Provider Details

I. General information

NPI: 1720286545
Provider Name (Legal Business Name): MIGDALIZ COTTO AYALA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7824 LAKE UNDERHILL RD STE B
ORLANDO FL
32822-8201
US

IV. Provider business mailing address

PO BOX 878
DAVENPORT FL
33836-0878
US

V. Phone/Fax

Practice location:
  • Phone: 407-627-0056
  • Fax: 407-273-1848
Mailing address:
  • Phone: 689-223-3898
  • Fax: 689-223-3898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16535
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: