Healthcare Provider Details

I. General information

NPI: 1760669675
Provider Name (Legal Business Name): LILIBETH IRIZARRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE DR CUETO #27
UTUADO PR
00641
US

IV. Provider business mailing address

PO BOX 27
UTUADO PR
00641-0027
US

V. Phone/Fax

Practice location:
  • Phone: 787-894-2190
  • Fax:
Mailing address:
  • Phone: 787-894-2190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number6436
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: