Healthcare Provider Details

I. General information

NPI: 1528510500
Provider Name (Legal Business Name): MARLENE AYALA CABRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVE HOSTOS 508 SUITE 101
SAN JUAN PR
00918-3264
US

IV. Provider business mailing address

500 AVE WEST MAIN APT 6A3 COND VILLAS DE BAYAMON
BAYAMON PR
00961-3871
US

V. Phone/Fax

Practice location:
  • Phone: 787-402-2068
  • Fax:
Mailing address:
  • Phone: 787-402-2068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number5899
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: