Healthcare Provider Details

I. General information

NPI: 1609835230
Provider Name (Legal Business Name): ARLENE IRIZARRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROAD 509 COTTO LAUREL
PONCE PR
00780-6205
US

IV. Provider business mailing address

PO BOX 3916
GUAYNABO PR
00970-3916
US

V. Phone/Fax

Practice location:
  • Phone: 787-999-0753
  • Fax: 787-999-0790
Mailing address:
  • Phone: 787-999-0753
  • Fax: 787-999-0790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12949
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: