Healthcare Provider Details

I. General information

NPI: 1235229931
Provider Name (Legal Business Name): AYALA ORTA MEDICAL SERVICE PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 AVE MATIAS BRUGMAN
LAS MARIAS PR
00670-2008
US

IV. Provider business mailing address

PO BOX 6431
MAYAGUEZ PR
00681-6431
US

V. Phone/Fax

Practice location:
  • Phone: 787-827-2433
  • Fax:
Mailing address:
  • Phone: 787-827-2433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENDA ORTA CARDONA
Title or Position: PROPIETARIA
Credential:
Phone: 787-827-2433