Healthcare Provider Details

I. General information

NPI: 1477901841
Provider Name (Legal Business Name): DARIEL J IRIZARRY DE JESUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 PONCE BYP STE 407
PONCE PR
00717-1322
US

IV. Provider business mailing address

126 EXT VILLA MILAGROS
CABO ROJO PR
00623-4453
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-8686
  • Fax:
Mailing address:
  • Phone: 787-538-3488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number22663
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: