Healthcare Provider Details

I. General information

NPI: 1417489105
Provider Name (Legal Business Name): RICARDO ALEXIS AYALA JIMENEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CALLE BAEZ
SAN JUAN PR
00917-5020
US

IV. Provider business mailing address

PO BOX 4198
GUAYNABO PR
00970-4198
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-6710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number23436
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: