Provider Demographics
NPI:1487497517
Name:AYALA DIAZ HEALTH AND WELLNESS LLC
Entity type:Organization
Organization Name:AYALA DIAZ HEALTH AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:AYALA DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-405-5703
Mailing Address - Street 1:F4 VIA SAN PAOLO
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-6805
Mailing Address - Country:US
Mailing Address - Phone:787-230-7557
Mailing Address - Fax:
Practice Address - Street 1:150 JOSE DE DIEGO AVE
Practice Address - Street 2:SAN JUAN HEALTH CENTRE SUITE 201
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907
Practice Address - Country:US
Practice Address - Phone:787-230-7557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care