Healthcare Provider Details

I. General information

NPI: 1104649912
Provider Name (Legal Business Name): DBA IRRIZARRY MEDICAL TRANSPORT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2024
Last Update Date: 11/01/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 129 KM19.6 BO CALLEJONES
LARES PR
00669
US

IV. Provider business mailing address

PO BOX 264
ANGELES PR
00611-0264
US

V. Phone/Fax

Practice location:
  • Phone: 787-214-2222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: HERIBERTO IRIZARRY
Title or Position: OWNER
Credential:
Phone: 787-214-2222