Provider Demographics
NPI:1063022333
Name:IRIZARRY, JORGE J (AUD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:J
Last Name:IRIZARRY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3735 HUNTINGTON PLACE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-3984
Mailing Address - Country:US
Mailing Address - Phone:787-649-0910
Mailing Address - Fax:
Practice Address - Street 1:2800 HILLVIEW ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3221
Practice Address - Country:US
Practice Address - Phone:941-316-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY2412231H00000X
FL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist