Healthcare Provider Details

I. General information

NPI: 1871582890
Provider Name (Legal Business Name): EFRAIN CASTRO IRIZARRY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 02/01/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN GERMAN MEDICAL PLAZA, SUITE 203 CARR #2 KM 174.3
SAN GERMAN PR
00683
US

IV. Provider business mailing address

PO BOX 1114
SAN GERMAN PR
00683-1114
US

V. Phone/Fax

Practice location:
  • Phone: 787-892-7690
  • Fax:
Mailing address:
  • Phone: 787-892-7690
  • Fax: 787-892-7690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000090
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: