Healthcare Provider Details

I. General information

NPI: 1912932179
Provider Name (Legal Business Name): PABLO ENRIQUE IRIZARRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 TORRE SAN PABLO STA CRZL ST
BAYAMON PR
00961-7038
US

IV. Provider business mailing address

304 TORRE SAN PABLO STA CRZL ST
BAYAMON PR
00961-7038
US

V. Phone/Fax

Practice location:
  • Phone: 787-780-3920
  • Fax: 787-780-2935
Mailing address:
  • Phone: 787-780-3920
  • Fax: 787-780-2935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number7425
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: