Healthcare Provider Details

I. General information

NPI: 1467311266
Provider Name (Legal Business Name): DAVID DANIEL BERRIOS IRIZARRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2026
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 VALLEY BROOK AVE
LYNDHURST NJ
07071-1825
US

IV. Provider business mailing address

132 VALLEY BROOK AVE
LYNDHURST NJ
07071-1825
US

V. Phone/Fax

Practice location:
  • Phone: 787-317-7577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86089115
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: