Healthcare Provider Details

I. General information

NPI: 1912982463
Provider Name (Legal Business Name): SANDRA IRAGORRI IRAGORRI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA IRAGORRI ALIX M.D.

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST YNHH CHILDREN'S HOSPITAL, WEST PAVILION, 2ND FLOOR
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

3181SWSAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4643
  • Fax: 203-785-3482
Mailing address:
  • Phone: 503-494-8311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD166290
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: