Healthcare Provider Details

I. General information

NPI: 1558893016
Provider Name (Legal Business Name): MRS. MAYRA IRIZARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 09/08/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE 25 DE JULIO #75-C
GUANICA PR
00653-2901
US

IV. Provider business mailing address

PO BOX 561002
GUAYANILLA PR
00656-3002
US

V. Phone/Fax

Practice location:
  • Phone: 787-205-1170
  • Fax: 787-821-1355
Mailing address:
  • Phone: 787-205-1170
  • Fax: 787-837-9608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number864
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: