Provider Demographics
NPI:1437126448
Name:SANTIAGO IRIZARRY, FERDINAND (MT ASCP MS)
Entity Type:Individual
Prefix:MR
First Name:FERDINAND
Middle Name:
Last Name:SANTIAGO IRIZARRY
Suffix:
Gender:M
Credentials:MT ASCP MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC03 BOX 13991
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-2804
Mailing Address - Country:US
Mailing Address - Phone:787-894-0908
Mailing Address - Fax:787-894-0908
Practice Address - Street 1:CARRETERA 111 KM 6.40
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641
Practice Address - Country:US
Practice Address - Phone:787-894-0908
Practice Address - Fax:787-894-0908
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1146246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30635Medicare ID - Type UnspecifiedTRIPLE S