MEDICARE: DR. IVELISSE IRIZARRY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	13044	PR

General Provider Information

NPI Number	:	1700884566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVELISSE IRIZARRY M.D.

Provider Business Mailing Address
First Line	:	1312 CALLE ALMENDRO
Second Line	:	HACIENDA BORINQUEN
City	:	CAGUAS
State	:	PR
Zip	:	00725-7527
Country	:	US
Telephone Number	:	787-743-2006
Fax Number	:	787-743-2006

Provider Business Practice Location Address
First Line	:	355 CALLE FONT MARTELO
Second Line	:
City	:	HUMACAO
State	:	PR
Zip	:	00791-3249
Country	:	US
Telephone Number	:	787-852-0768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	07/09/2007

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