Healthcare Provider Details

I. General information

NPI: 1538297718
Provider Name (Legal Business Name): CESAR A. IRIZARRY D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CALLE BELT RAMEY BASE
AGUADILLA PR
00603-1105
US

IV. Provider business mailing address

#123 D STREET RAMEY BASE
AGUADILLA PR
00603
US

V. Phone/Fax

Practice location:
  • Phone: 787-890-0575
  • Fax: 787-890-0575
Mailing address:
  • Phone: 787-890-0575
  • Fax: 787-890-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number267
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: