Healthcare Provider Details

I. General information

NPI: 1023626017
Provider Name (Legal Business Name): CHRISTIAN R IRIZARRY CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PHSU, 388 ZONA INDUSTRIAL REPARADA 2, PONCE, PR 00716
PONCE PR
00716
US

IV. Provider business mailing address

PO BOX 7004
PONCE PR
00732-7004
US

V. Phone/Fax

Practice location:
  • Phone: 787-840-2575
  • Fax:
Mailing address:
  • Phone: 787-840-2575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number23939
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: