Provider Demographics
NPI:1558399063
Name:IRIZARRY, ROLANDO (MD)
Entity Type:Individual
Prefix:MR
First Name:ROLANDO
Middle Name:
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 1:426 CALLE REY LUIS
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-3170
Mailing Address - Country:US
Mailing Address - Phone:787-772-8322
Mailing Address - Fax:787-772-8322
Practice Address - Street 1:531A
Practice Address - Street 2:SERGIO CUEVAS BUSTAMANTE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-772-8322
Practice Address - Fax:787-772-8322
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR118842084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G40981Medicare ID - Type Unspecified