Healthcare Provider Details

I. General information

NPI: 1518317692
Provider Name (Legal Business Name): ALFREDO AYALA DIAZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2016
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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number22229
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: