Healthcare Provider Details

I. General information

NPI: 1114617560
Provider Name (Legal Business Name): BIANCA MIKAELA IRIZARRY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5102 S BROADWAY
ENGLEWOOD CO
80113-6706
US

IV. Provider business mailing address

3481 S FENTON ST APT A106
DENVER CO
80227-5518
US

V. Phone/Fax

Practice location:
  • Phone: 720-457-9100
  • Fax:
Mailing address:
  • Phone: 386-292-6861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007916
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: