Provider Demographics
NPI:1093910747
Name:RAMIREZ IRIZARRY, KRISTINA INES (DC)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:INES
Last Name:RAMIREZ IRIZARRY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624-0763
Mailing Address - Country:US
Mailing Address - Phone:939-274-2878
Mailing Address - Fax:
Practice Address - Street 1:23 CALLE MATIENZO CINTRON STE 1
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3915
Practice Address - Country:US
Practice Address - Phone:939-274-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-20
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC009911111N00000X
PR438111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ER034AOtherMEDICARE PTAN