Provider Demographics
NPI:1376710988
Name:DIAZ IRIZARRY, RICARDO OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:OMAR
Last Name:DIAZ 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:PO BOX 277
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00960-0277
Mailing Address - Country:US
Mailing Address - Phone:787-501-5724
Mailing Address - Fax:
Practice Address - Street 1:URB. LOMAS VERDES
Practice Address - Street 2:2Z3 JACINTO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956
Practice Address - Country:US
Practice Address - Phone:787-501-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17131146D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant