Healthcare Provider Details

I. General information

NPI: 1144874009
Provider Name (Legal Business Name): CARLOTA OTILIA IZAGUIRRE DNP, CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2019
Last Update Date: 10/27/2022
Certification Date: 10/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

550 PROSPECT PL APT 304
BROOKLYN NY
11238-6938
US

V. Phone/Fax

Practice location:
  • Phone: 718-208-8159
  • Fax:
Mailing address:
  • Phone: 718-208-8159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN02533
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: