Provider Demographics
NPI:1790916104
Name:EDWIN IRIZARRY RODRIGUEZ
Entity Type:Organization
Organization Name:EDWIN IRIZARRY RODRIGUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:IRIZARRY RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-239-5463
Mailing Address - Street 1:CARR 833 KM 3.6 RAMAL 174
Mailing Address - Street 2:BO. GUARAGUAO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00971-9541
Mailing Address - Country:US
Mailing Address - Phone:787-239-5463
Mailing Address - Fax:
Practice Address - Street 1:HC 01 BOX 6168
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971-0000
Practice Address - Country:US
Practice Address - Phone:787-239-5463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRTCAMB 5503416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport