=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811254782
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YOHAIMI ESLIMENCHI COSME AYALA M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2012
-----------------------------------------------------
Last Update Date | 03/07/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3319 SR7 SUITE 109
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-985-4375
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9780 QUAYE SIDE DR UNIT 4-104
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33411-5822
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-667-2482
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 286113
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------