Healthcare Provider Details

I. General information

NPI: 1164585865
Provider Name (Legal Business Name): NERMARI IRIZARRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STREET 111, KM 1.9 BOX 379
LARES PR
00669
US

IV. Provider business mailing address

PO BOX 236
JAYUYA PR
00664-0236
US

V. Phone/Fax

Practice location:
  • Phone: 787-897-1730
  • Fax:
Mailing address:
  • Phone: 787-828-1821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number16653
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: