Provider Demographics
NPI:1437165560
Name:IRIZARRY, GLADYS M (MD)
Entity Type:Individual
Prefix:MISS
First Name:GLADYS
Middle Name:M
Last Name:IRIZARRY
Suffix:
Gender:F
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:CAMPOS DE MONTEHIEDRA
Mailing Address - Street 2:JUNCAL 742
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-510-6716
Mailing Address - Fax:787-267-4236
Practice Address - Street 1:CENTRO CARDIOVASCULAR DE PR Y EL CARIBE
Practice Address - Street 2:CENTRO MEDICO - DEPT ANESTESIA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-510-6716
Practice Address - Fax:787-267-4236
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13420207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG94969Medicare UPIN
PR20897Medicare ID - Type Unspecified