Provider Demographics
NPI:1679784490
Name:IRIZARRY, MARIA A (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:A
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIA
Other - Middle Name:A
Other - Last Name:IRIZARRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4 CALLE OVIEDO
Mailing Address - Street 2:TORRIMAR
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00966-3008
Mailing Address - Country:US
Mailing Address - Phone:787-783-9123
Mailing Address - Fax:
Practice Address - Street 1:4 CALLE OVIEDO
Practice Address - Street 2:TORRIMAR
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00966-3008
Practice Address - Country:US
Practice Address - Phone:787-783-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10050208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR10050OtherPRMEDICAL LICENCE NUMBER