Healthcare Provider Details

I. General information

NPI: 1972035269
Provider Name (Legal Business Name): EDUARDO ANDRES IRIZARRY NIEVES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 AVE ESCORIAL URB CAPARRA HEIGHTS
SAN JUAN PR
00920-3508
US

IV. Provider business mailing address

PO BOX 367284
SAN JUAN PR
00936-7284
US

V. Phone/Fax

Practice location:
  • Phone: 787-781-7478
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number22636
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: