Healthcare Provider Details

I. General information

NPI: 1245262559
Provider Name (Legal Business Name): MOISES DUVIEL IRIZARRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/05/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3661 S MIAMI AVE STE 902
MIAMI FL
33133-4214
US

IV. Provider business mailing address

3661 S MIAMI AVE STE 902
MIAMI FL
33133-4214
US

V. Phone/Fax

Practice location:
  • Phone: 305-963-9095
  • Fax: 305-284-2568
Mailing address:
  • Phone: 305-396-9095
  • Fax: 305-285-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number16189
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME96980
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: