Healthcare Provider Details

I. General information

NPI: 1316908007
Provider Name (Legal Business Name): KENNETH RIVERA AYALA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 CARR 14 APT 33303 COND LA ALBORADA
COTO LAUREL PR
00780-2327
US

IV. Provider business mailing address

2201 CARR 14 APT 33303
COTO LAUREL PR
00780-2327
US

V. Phone/Fax

Practice location:
  • Phone: 787-630-0959
  • Fax:
Mailing address:
  • Phone: 787-630-0959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12788
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: