Provider Demographics
NPI:1316186075
Name:RICARDO F IZURIETA MD PA
Entity Type:Organization
Organization Name:RICARDO F IZURIETA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:F
Authorized Official - Last Name:IZURIETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-366-3738
Mailing Address - Street 1:8709 HAMPSHIRE GLEN DR S
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9567
Mailing Address - Country:US
Mailing Address - Phone:904-366-3738
Mailing Address - Fax:904-276-2106
Practice Address - Street 1:8709 HAMPSHIRE GLEN DR S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9567
Practice Address - Country:US
Practice Address - Phone:904-366-3738
Practice Address - Fax:904-276-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80907207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty