Healthcare Provider Details

I. General information

NPI: 1649994872
Provider Name (Legal Business Name): VIRNA MARIE NAZARIO AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA #2 , KM.11.7
BAYAMON PR
00959
US

IV. Provider business mailing address

PO BOX 473
SABANA GRANDE PR
00637-0473
US

V. Phone/Fax

Practice location:
  • Phone: 787-474-8282
  • Fax:
Mailing address:
  • Phone: 787-909-2225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number24464
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: