Provider Demographics
NPI:1346238318
Name:RAMIREZ IRIZARRY, ENRIQUE SR (MD)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:RAMIREZ IRIZARRY
Suffix:SR
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 1:20 SUR 65 INFANTRY ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667
Mailing Address - Country:US
Mailing Address - Phone:787-899-4452
Mailing Address - Fax:787-899-2163
Practice Address - Street 1:20 CALLE 65 INFANTERIA S
Practice Address - Street 2:SUITE 4
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-2013
Practice Address - Country:US
Practice Address - Phone:787-899-4452
Practice Address - Fax:787-899-2163
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5934208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0027218Medicare PIN
C79637Medicare UPIN