Healthcare Provider Details

I. General information

NPI: 1164439857
Provider Name (Legal Business Name): ALFREDO IRIZARRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 MUNOZ RIVERA ST.
GUAYANILLA PR
00656
US

IV. Provider business mailing address

PO BOX 560062
GUAYANILLA PR
00656-0062
US

V. Phone/Fax

Practice location:
  • Phone: 787-835-7492
  • Fax: 787-835-7492
Mailing address:
  • Phone: 787-290-2019
  • Fax: 787-835-7492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number8584
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: