Basic Information
| Provider Information | |||||||||
| NPI: | 1104142173 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYUSO | ||||||||
| FirstName: | ANDRES | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1658 ST. VINCENTS WAY | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042641628 | ||||||||
| FaxNumber: | 9042648386 | ||||||||
| Practice Location | |||||||||
| Address1: | 1658 ST. VINCENTS WAY | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | MIDDLEBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042641628 | ||||||||
| FaxNumber: | 9042648386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2010 | ||||||||
| LastUpdateDate: | 06/15/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | ME121426 | FL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.