Provider Demographics
NPI:1639610546
Name:BURGOS IRIZARRY, KARELYS
Entity Type:Individual
Prefix:
First Name:KARELYS
Middle Name:
Last Name:BURGOS 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 1:60 AVE WINSTON CHURCHILL
Mailing Address - Street 2:APT 103
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-365-0721
Mailing Address - Fax:
Practice Address - Street 1:60 AVE WINSTON CHURCHILL
Practice Address - Street 2:APT 103
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-365-0721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-10
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program