Healthcare Provider Details

I. General information

NPI: 1265526875
Provider Name (Legal Business Name): ZULEIKA BULTRON AYALA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ITURREGUI PLAZA SUITE 217-A
SAN JUAN PR
00926-0000
US

IV. Provider business mailing address

ITURREGUI PLAZA SUITE 217-A
SAN JUAN PR
00926-0000
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-5501
  • Fax: 787-768-8094
Mailing address:
  • Phone: 787-768-5501
  • Fax: 787-768-8094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number000814
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: