MEDICARE: CARLA AYALA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	14346	PR

General Provider Information

NPI Number	:	1386184349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA AYALA MD

Provider Business Mailing Address
First Line	:	2A4 URB ESTANCIAS DE CERRO GORDO
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00957
Country	:	US
Telephone Number	:	787-672-2494
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 CALLE 4 # A
Second Line	:	URB.ESTANCIAS DE CERRO GORDO
City	:	BAYAMON
State	:	PR
Zip	:	00957-6919
Country	:	US
Telephone Number	:	787-672-2494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2017
Last Update Date	:	02/24/2017

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