Provider Demographics
NPI:1518926237
Name:IRIZARRY, RICARDO ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:ENRIQUE
Last Name: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 1:2715 HYLTON AVE
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-2715
Mailing Address - Country:US
Mailing Address - Phone:956-381-1443
Mailing Address - Fax:956-289-7254
Practice Address - Street 1:4701 S SUGAR RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7012
Practice Address - Country:US
Practice Address - Phone:956-289-7000
Practice Address - Fax:956-289-7254
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM17852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXV0141096OtherDPS
TX8K9955OtherBLUE SHIELD OF TEXAS
TX176524001Medicaid
TX176524001Medicaid
TXI42327Medicare UPIN
TXV0141096OtherDPS