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NPI Code Detail

MEDICARE: MR. RAUL IZQUIERDO JR.

MEDICARE:  MR. RAUL  IZQUIERDO JR.
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
1172A00000XDriver47-2871756NY

General Provider Information

NPI Number : 1881149706
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RAUL IZQUIERDO JR.
Provider Business Mailing Address
First Line : 1509 CORTELYOU RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-5607
Country : US
Telephone Number : 718-940-1212
Fax Number : 718-462-4098
Provider Business Practice Location Address
First Line : 1509 CORTELYOU RD
Second Line :
City : BROOKLYN
State : NY
Zip : 11226-5607
Country : US
Telephone Number : 718-940-1212
Fax Number : 718-462-4098
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2016
Last Update Date : 08/20/2016

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Directions to “ MR. RAUL IZQUIERDO JR. ” Practice Location

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