Provider Demographics
NPI:1790061984
Name:IRIZARRY, CARLOS E (MD)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:E
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 1:421 CALLE SAN JOVINO
Mailing Address - Street 2:URB. SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4212
Mailing Address - Country:US
Mailing Address - Phone:787-747-1374
Mailing Address - Fax:
Practice Address - Street 1:AVE. RAFAEL CORDERO FINAL ESQ. TROCHE
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-747-4137
Practice Address - Fax:787-745-0559
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR893235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist