Healthcare Provider Details

I. General information

NPI: 1548273113
Provider Name (Legal Business Name): MARITZA I. IRIZARRY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 04/06/2017
Certification Date:
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

5040 N 15TH AVE SUITE 104
PHOENIX AZ
85015-3328
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: MARITZA I IRIZARRY
Title or Position: PRESIDENT
Credential: MD
Phone: 623-849-2055