Provider Demographics
NPI:1093839755
Name:IRIZARRY, HECTOR L (MD)
Entity Type:Individual
Prefix:DR
First Name:HECTOR
Middle Name:L
Last Name:IRIZARRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CENTRO INTERNACIONAL DE MERCAD
Mailing Address - Street 2:#90 RD. 165, SUITE 302
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-474-2280
Mailing Address - Fax:
Practice Address - Street 1:CENTRO INTERNACIONAL DE MERCADEO
Practice Address - Street 2:#90 RD. 165, SUITE 302
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968
Practice Address - Country:US
Practice Address - Phone:787-474-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13171208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR84284OtherTRIPLE S-BLUE SHIELD
PR9600074OtherHUMANA HEALTH PLANS
PR84284Medicare ID - Type Unspecified