Healthcare Provider Details

I. General information

NPI: 1740250919
Provider Name (Legal Business Name): LYDIA IRIZARRY GONZALEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 12/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2431 AVE LAS AMERICAS EDIF.PORRATA PILA SUITE 304
PONCE PR
00717-2113
US

IV. Provider business mailing address

2431 AVE LAS AMERICAS EDIF.PORRATA PILA SUITE 304
PONCE PR
00717-2113
US

V. Phone/Fax

Practice location:
  • Phone: 787-844-4141
  • Fax: 787-259-0031
Mailing address:
  • Phone: 787-844-4141
  • Fax: 787-259-0031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number10282
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number10282
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: