MEDICARE: VIRNA MARIE NAZARIO AYALA

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	208000000X	Pediatrics Physician	24464	PR

General Provider Information

NPI Number	:	1649994872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRNA MARIE NAZARIO AYALA

Provider Business Mailing Address
First Line	:	PO BOX 473
Second Line	:
City	:	SABANA GRANDE
State	:	PR
Zip	:	00637-0473
Country	:	US
Telephone Number	:	787-909-2225
Fax Number	:

Provider Business Practice Location Address
First Line	:	CARRETERA #2 , KM.11.7
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00959
Country	:	US
Telephone Number	:	787-474-8282
Fax Number	:

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

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	06/08/2026

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