Healthcare Provider Details

I. General information

NPI: 1891893509
Provider Name (Legal Business Name): MRS. AIDA V. IRIZARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FLORENTINO ROMAN VILLA SAN ANTON
CAROLINA PR
00987
US

IV. Provider business mailing address

203 ST. 4F-28 COLINAS DE FAIRVIEW
TRUJILLO ALTO PR
00976
US

V. Phone/Fax

Practice location:
  • Phone: 787-768-4366
  • Fax: 787-768-4367
Mailing address:
  • Phone: 787-755-6741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number1789
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: