Basic Information
| Provider Information | |||||||||
| NPI: | 1992367114 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AYALA DIAZ | ||||||||
| FirstName: | AMBAR | ||||||||
| MiddleName: | JOCELIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 CAYUGA RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142251950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168193420 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 301 CAYUGA RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | CHEEKTOWAGA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142251950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168163420 | ||||||||
| FaxNumber: | 7168193430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2019 | ||||||||
| LastUpdateDate: | 07/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.