MEDICARE: MAURO IRANZO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	15344	PR

General Provider Information

NPI Number	:	1871585208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAURO IRANZO M.D.

Provider Business Mailing Address
First Line	:	138 AVE WINSTON CHURCHILL
Second Line	:	PMB 526
City	:	SAN JUAN
State	:	PR
Zip	:	00926-6013
Country	:	US
Telephone Number	:	787-292-7021
Fax Number	:

Provider Business Practice Location Address
First Line	:	UPR HOSPITAL-65TH INFANTERIA AVE.
Second Line	:	3RD FLOOR-DPT. OF SURGERY
City	:	CAROLINA
State	:	PR
Zip	:	00984
Country	:	US
Telephone Number	:	787-757-1800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	07/08/2007

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