Healthcare Provider Details

I. General information

NPI: 1376711234
Provider Name (Legal Business Name): LUIS ERNESTO GARCIA - IRIZARRY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ASEM - RADIOLOGIA 2DO PISO CENTRO MEDICO DE PUERTO RICO, BO. MONACILLOS
SAN JUAN PR
00935
US

IV. Provider business mailing address

RADIOLOGIA RCM PO BOX 29134
SAN JUAN PR
00935
US

V. Phone/Fax

Practice location:
  • Phone: 787-777-3535
  • Fax: 787-777-3858
Mailing address:
  • Phone: 787-777-3535
  • Fax: 787-777-3858

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number040569
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number104933
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number018493
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: