Provider Demographics
NPI:1740806199
Name:NAVARRO ESCALERA, IRELIS GABRIELA
Entity Type:Individual
Prefix:
First Name:IRELIS
Middle Name:GABRIELA
Last Name:NAVARRO ESCALERA
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 600
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-0600
Mailing Address - Country:US
Mailing Address - Phone:787-652-9200
Mailing Address - Fax:
Practice Address - Street 1:410 AVE HOSTOS STE 2
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00682-1500
Practice Address - Country:US
Practice Address - Phone:787-652-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-22
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR36274-R207Q00000X
PR36-274R390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine