Healthcare Provider Details

I. General information

NPI: 1265546535
Provider Name (Legal Business Name): JOSE M AYALA AND RAFAEL BAQUERO PTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 12/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CONSOLIDATED MALL CALLE GAUTIER BENITEZ SUITE 307
CAGUAS PR
00726
US

IV. Provider business mailing address

PO BOX 6628
CAGUAS PR
00726-6628
US

V. Phone/Fax

Practice location:
  • Phone: 787-746-7441
  • Fax: 787-746-3190
Mailing address:
  • Phone: 787-746-7441
  • Fax: 787-746-3190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MISS GLORIA M SIERRA-RUIZ
Title or Position: SECRETARY
Credential:
Phone: 787-746-7441