Provider Demographics
NPI:1376780155
Name:IRIZARRY RODRIGUEZ, EDWIN SR
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:
Last Name:IRIZARRY RODRIGUEZ
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 6168
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9541
Mailing Address - Country:US
Mailing Address - Phone:787-239-5463
Mailing Address - Fax:
Practice Address - Street 1:CARR. 833 K.M 3.6 RAMAL 174 BO. GUARAGUAO
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971-9541
Practice Address - Country:US
Practice Address - Phone:787-239-5463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTC AMB 5503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport