MEDICARE: MRS. LYDIA IRIZARRY GONZALEZ 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	174400000X	Specialist	10282	PR
2	2080P0205X	Pediatric Endocrinology Physician	10282	PR

General Provider Information

NPI Number	:	1740250919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LYDIA IRIZARRY GONZALEZ M.D.

Provider Business Mailing Address
First Line	:	2431 AVE LAS AMERICAS
Second Line	:	EDIF.PORRATA PILA SUITE 304
City	:	PONCE
State	:	PR
Zip	:	00717-2113
Country	:	US
Telephone Number	:	787-844-4141
Fax Number	:	787-259-0031

Provider Business Practice Location Address
First Line	:	2431 AVE LAS AMERICAS
Second Line	:	EDIF.PORRATA PILA SUITE 304
City	:	PONCE
State	:	PR
Zip	:	00717-2113
Country	:	US
Telephone Number	:	787-844-4141
Fax Number	:	787-259-0031

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	12/11/2014

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Directions to “ MRS. LYDIA IRIZARRY GONZALEZ M.D.” Practice Location

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