=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508993072
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MISS ROSALYN YANIRA AYALA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 C URB. SYLVIA C 18
-----------------------------------------------------
City | COROZAL
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-409-5189
-----------------------------------------------------
Fax | 787-859-4969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | CALLE 1 URB. SYLVIA C 18
-----------------------------------------------------
City | COROZAL
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00783
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-409-5189
-----------------------------------------------------
Fax | 787-859-4969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183700000X
-----------------------------------------------------
Taxonomy Name | Pharmacy Technician
-----------------------------------------------------
License Number | 5369
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------