Healthcare Provider Details

I. General information

NPI: 1518161421
Provider Name (Legal Business Name): ANGEL RAFAEL AYALA SANCHEZ SR. PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 149 KM 7.7 RAMAL INTERIOR 643 BO ARRIBA SALIENTE
MANATI PR
00674
US

IV. Provider business mailing address

PRADERAS DE MOROVIS SUR 68 CALLE VERANO
MOROVIS PR
00687
US

V. Phone/Fax

Practice location:
  • Phone: 787-375-7608
  • Fax:
Mailing address:
  • Phone: 787-375-7608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2625
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: