Provider Demographics
NPI:1144776063
Name:SANTIAGO IRIZARRY, MARISOL (MD)
Entity Type:Individual
Prefix:
First Name:MARISOL
Middle Name:
Last Name:SANTIAGO IRIZARRY
Suffix:
Gender:F
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:HC 4 BOX 8730
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-7645
Mailing Address - Country:US
Mailing Address - Phone:787-650-7272
Mailing Address - Fax:787-767-7011
Practice Address - Street 1:HOSPITAL PAVIA ARECIBO
Practice Address - Street 2:CARRETERA 129, KM 1.0 AV. SAN LUIS
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-650-7272
Practice Address - Fax:787-767-7011
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19258207RI0200X, 207R00000X
PR19,258390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program