Healthcare Provider Details

I. General information

NPI: 1487497517
Provider Name (Legal Business Name): AYALA DIAZ HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 CALLE GEORGETTI
NARANJITO PR
00783
US

IV. Provider business mailing address

9507 VIA PELICANOS
TOA BAJA PR
00949-4385
US

V. Phone/Fax

Practice location:
  • Phone: 787-230-7557
  • Fax:
Mailing address:
  • Phone: 787-230-7557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ALFREDO AYALA DIAZ
Title or Position: OWNER
Credential: MD
Phone: 787-405-5703