Healthcare Provider Details

I. General information

NPI: 1437597432
Provider Name (Legal Business Name): DUVIEL IRIZARRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 06/16/2025
Certification Date: 06/02/2025
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

1409 NE 17TH WAY
FORT LAUDERDALE FL
33304-1333
US

V. Phone/Fax

Practice location:
  • Phone: 305-396-9095
  • Fax: 305-428-2568
Mailing address:
  • Phone: 548-493-3389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number96980
License Number StateFL

VIII. Authorized Official

Name: DR. MOISES DUVIEL IRIZARRY-ROMAN
Title or Position: CEO
Credential: MD
Phone: 305-396-9095