Basic Information
| Provider Information | |||||||||
| NPI: | 1497195275 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | DE AYALA | ||||||||
| FirstName: | RAFAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PLAZA 21 MF-69 MARINA BAHIA | ||||||||
| Address2: | |||||||||
| City: | CATANO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009626721 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | UNIVERSITY DISTRICT HOSPITAL PUERTO RICO MEDICAL CENTER | ||||||||
| Address2: | BO MONACILLOS | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877540101 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2013 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208600000X | 85142 | GA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.