Provider Demographics
NPI:1013996719
Name:IZQUIERDO-RIVERA, JULIO ENRIQUE (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:ENRIQUE
Last Name:IZQUIERDO-RIVERA
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:PO BOX 1082
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1082
Mailing Address - Country:US
Mailing Address - Phone:787-831-3697
Mailing Address - Fax:787-892-9290
Practice Address - Street 1:PLAZA METROPOLITANA #102
Practice Address - Street 2:CALLE HERNAN ALVAREZ
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-3318
Practice Address - Fax:787-892-9290
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8639208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
E20939Medicare UPIN
PR0081625Medicare ID - Type Unspecified