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General NPI Number Information
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NPI Number | 1417996919
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Entity Type | Individual
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Provider Name | HEIDI MELISSA AYALA CARDONA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 10/05/2011
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Provider Practice Location Address
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Address Line | EDIFICIO PROFESIONAL OFICINA 202 HOSPITAL MENONITA CALLE JOSE C VAZQUEZ
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City | AIBONITO
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State | PR
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Zip | 00705
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Country | US
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Telephone | 787-735-7110
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Fax | 787-991-3041
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Provider Business Mailing Address
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Address Line | PO BOX 2300 PMB # 21
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City | AIBONITO
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State | PR
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Zip | 00705-2300
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Country | US
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Telephone | 939-642-2033
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 13948
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License Number State | PR
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