Provider Demographics
NPI:1558893016
Name:IRIZARRY, MAYRA
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 561002
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-3002
Mailing Address - Country:US
Mailing Address - Phone:787-205-1170
Mailing Address - Fax:787-837-9608
Practice Address - Street 1:56 CALLE COMERCIO
Practice Address - Street 2:
Practice Address - City:JUANA DIAZ
Practice Address - State:PR
Practice Address - Zip Code:00795-1633
Practice Address - Country:US
Practice Address - Phone:787-205-1170
Practice Address - Fax:787-837-9608
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR864156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician