Provider Demographics
NPI:1982652772
Name:IZQUIERDO ENCARNACION, NATALIO (MD)
Entity Type:Individual
Prefix:DR
First Name:NATALIO
Middle Name:
Last Name:IZQUIERDO ENCARNACION
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:TORRE SAN FRANCISCO
Mailing Address - Street 2:SUITE 310, DE DIEGO AVE 369
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00923
Mailing Address - Country:US
Mailing Address - Phone:787-767-8872
Mailing Address - Fax:787-282-8342
Practice Address - Street 1:369 DE DIEGO AVE. , TORRE SAN FRANCISCO
Practice Address - Street 2:SUITE 310
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-767-8872
Practice Address - Fax:787-282-8342
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2018-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9133207WX0009X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR83239Medicare ID - Type Unspecified
PRF34351Medicare UPIN