Healthcare Provider Details

I. General information

NPI: 1518569136
Provider Name (Legal Business Name): AYALA TROCHE, MD, C.S.P.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 173
SAN GERMAN PR
00683
US

IV. Provider business mailing address

URB BORINQUEN N21 CALLE PEDRO FLORES
CABO ROJO PR
00623
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-1860
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSE MANUEL AYALA
Title or Position: PRESIDENT
Credential: MD
Phone: 787-502-6306