Basic Information
| Provider Information | |||||||||
| NPI: | 1538768338 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AYALA-VILLALOBOS | ||||||||
| FirstName: | YAIDELISE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS, SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | HC 2 BOX 7582 | ||||||||
| Address2: | |||||||||
| City: | CIALES | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006389720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7874863306 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | BO COTTO NORTE URB VILLA MARIA B-4 | ||||||||
| Address2: | |||||||||
| City: | MANATI | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00674 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7879153000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2020 | ||||||||
| LastUpdateDate: | 10/22/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.