Healthcare Provider Details

I. General information

NPI: 1477734531
Provider Name (Legal Business Name): MARITZA IVETTE IRIZARRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2007
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 N 15TH AVE SUITE 104
PHOENIX AZ
85015-3328
US

IV. Provider business mailing address

20701 N SCOTTSDALE RD SUITE 107-427
SCOTTSDALE AZ
85255-6413
US

V. Phone/Fax

Practice location:
  • Phone: 623-245-0505
  • Fax: 623-245-3475
Mailing address:
  • Phone: 623-245-0505
  • Fax: 623-245-3475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number21934
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: