Provider Demographics
NPI:1467465773
Name:IRIZARRY RODRIGUEZ, IVAN FERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:FERNANDO
Last Name:IRIZARRY RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:URB MILAVILLE
Mailing Address - Street 2:17 CALLE CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927-5120
Mailing Address - Country:US
Mailing Address - Phone:787-366-0517
Mailing Address - Fax:787-754-6201
Practice Address - Street 1:EDIFICIO PROFESIONAL HOSPITAL MENONITA CAYEY
Practice Address - Street 2:SUITE 307
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-2871
Practice Address - Fax:787-263-6581
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2019-06-28
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Provider Licenses
StateLicense IDTaxonomies
PR14633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22334Medicare ID - Type Unspecified
PR135219Medicare UPIN