Provider Demographics
NPI:1891893509
Name:IRIZARRY, AIDA V
Entity Type:Individual
Prefix:MRS
First Name:AIDA
Middle Name:V
Last Name:IRIZARRY
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 1:203 ST.
Mailing Address - Street 2:4F-28 COLINAS DE FAIRVIEW
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-755-6741
Mailing Address - Fax:
Practice Address - Street 1:FLORENTINO ROMAN
Practice Address - Street 2:VILLA SAN ANTON
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987
Practice Address - Country:US
Practice Address - Phone:787-768-4366
Practice Address - Fax:787-768-4367
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist