Provider Demographics
NPI:1437597432
Name:DUVIEL IRIZARRY LLC
Entity Type:Organization
Organization Name:DUVIEL IRIZARRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MOISES
Authorized Official - Middle Name:DUVIEL
Authorized Official - Last Name:IRIZARRY-ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-396-9095
Mailing Address - Street 1:6389 BAY CLUB DR
Mailing Address - Street 2:APT 4
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1638
Mailing Address - Country:US
Mailing Address - Phone:787-240-9066
Mailing Address - Fax:
Practice Address - Street 1:1717 N BAYSHORE DR STE 230
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33132-1195
Practice Address - Country:US
Practice Address - Phone:305-396-9095
Practice Address - Fax:305-428-2568
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96980261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty