Healthcare Provider Details

I. General information

NPI: 1982652772
Provider Name (Legal Business Name): NATALIO IZQUIERDO ENCARNACION MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 11/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

369 DE DIEGO AVE. , TORRE SAN FRANCISCO SUITE 310
SAN JUAN PR
00923
US

IV. Provider business mailing address

TORRE SAN FRANCISCO SUITE 310, DE DIEGO AVE 369
SAN JUAN PR
00923
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-8872
  • Fax: 787-282-8342
Mailing address:
  • Phone: 787-767-8872
  • Fax: 787-282-8342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number9133
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number9133
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: