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General NPI Number Information
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NPI Number | 1306461579
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Entity Type | Individual
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Provider Name | AMAURY O AYALA LMT
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Gender | Male
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 06/12/2020
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Provider Practice Location Address
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Address Line | 1739 CARR 8838
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City | SAN JUAN
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State | PR
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Zip | 00926-2741
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Country | US
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Telephone | 787-299-9863
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Fax |
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Provider Business Mailing Address
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Address Line | 713 CALLE ASTER
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City | SAN JUAN
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State | PR
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Zip | 00926-4817
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Country | US
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Telephone | 787-299-9863
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 0966
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License Number State | PR
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