Provider Demographics
NPI:1790915536
Name:IZQUIERDO, EMMANUEL J (PSY D)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:J
Last Name:IZQUIERDO
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 CALLE LOIZA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00911-1819
Mailing Address - Country:US
Mailing Address - Phone:787-529-7443
Mailing Address - Fax:
Practice Address - Street 1:1750 CALLE LOIZA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00911-1819
Practice Address - Country:US
Practice Address - Phone:787-529-7443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3376103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical