Healthcare Provider Details

I. General information

NPI: 1154490449
Provider Name (Legal Business Name): FERNANDO LAPETINA IRIZARRY M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CALLE VANDA
GUAYNABO PR
00966-3171
US

IV. Provider business mailing address

15 CALLE VANDA
GUAYNABO PR
00966-3171
US

V. Phone/Fax

Practice location:
  • Phone: 787-727-4737
  • Fax:
Mailing address:
  • Phone: 787-727-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13445
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: