Provider Demographics
NPI:1508643230
Name:ORTIZ IRIZARRY, RANDY (MD)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:
Last Name:ORTIZ IRIZARRY
Suffix:
Gender:M
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:JARDINES DE SANTA ANA
Mailing Address - Street 2:F-5 CALLE 5
Mailing Address - City:COAMO
Mailing Address - State:PR
Mailing Address - Zip Code:00769
Mailing Address - Country:US
Mailing Address - Phone:787-702-2018
Mailing Address - Fax:
Practice Address - Street 1:JARDINES DE SANTA ANA
Practice Address - Street 2:F-5 CALLE 5
Practice Address - City:COAMO
Practice Address - State:PR
Practice Address - Zip Code:00769
Practice Address - Country:US
Practice Address - Phone:787-702-2018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR023508208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice