Healthcare Provider Details

I. General information

NPI: 1578758686
Provider Name (Legal Business Name): JADIRA IRIZARRY-PADILLA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 02/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 SE 110TH STREET RD
BELLEVIEW FL
34420-3525
US

IV. Provider business mailing address

203 E SILVER SPRINGS BLVD # 101
OCALA FL
34470-5813
US

V. Phone/Fax

Practice location:
  • Phone: 352-732-6599
  • Fax: 352-307-4417
Mailing address:
  • Phone: 352-732-6599
  • Fax: 352-732-4816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17302
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME125235
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: