Healthcare Provider Details

I. General information

NPI: 1427304880
Provider Name (Legal Business Name): EDWIN IRIZARRY SLP, AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2012
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 CALLE ENRIQUE SANABRIA
ADJUNTAS PR
00601-2147
US

IV. Provider business mailing address

23 CALLE ENRIQUE SANABRIA
ADJUNTAS PR
00601-2147
US

V. Phone/Fax

Practice location:
  • Phone: 787-203-4937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number932
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number604
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: