Provider Demographics
NPI:1679520068
Name:IRIZARRY, LUIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
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 1:4G17 CALLE 205
Mailing Address - Street 2:COLINAS FAIRVIEW
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-8221
Mailing Address - Country:US
Mailing Address - Phone:787-769-4079
Mailing Address - Fax:
Practice Address - Street 1:4G17 CALLE 205
Practice Address - Street 2:COLINAS FAIRVIEW
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976-8221
Practice Address - Country:US
Practice Address - Phone:787-769-4079
Practice Address - Fax:787-748-3008
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10820174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist