Healthcare Provider Details

I. General information

NPI: 1093888703
Provider Name (Legal Business Name): EUGENIA AYALA RIVERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE CASTIGLIONI S4 BAYAMON GARDENS
BAYAMON PR
00956
US

IV. Provider business mailing address

PO BOX 4009
BAYAMON PR
00958-1009
US

V. Phone/Fax

Practice location:
  • Phone: 787-797-6767
  • Fax: 787-797-6767
Mailing address:
  • Phone: 787-797-6767
  • Fax: 787-797-7744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8697
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: