Provider Demographics
NPI:1174087878
Name:AYALA RODRIGUEZ, CARLOS JAVIER
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:JAVIER
Last Name:AYALA RODRIGUEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:F7 CALLE C
Mailing Address - Street 2:
Mailing Address - City:HUMACAO
Mailing Address - State:PR
Mailing Address - Zip Code:00791-4221
Mailing Address - Country:US
Mailing Address - Phone:787-224-8204
Mailing Address - Fax:
Practice Address - Street 1:F7 CALLE C
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-4221
Practice Address - Country:US
Practice Address - Phone:787-224-8204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-27
Last Update Date:2019-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program