Provider Demographics
NPI:1255824090
Name:IZQUIERDO, JOSE RAMIRO (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RAMIRO
Last Name:IZQUIERDO
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 800498
Mailing Address - Street 2:
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780-0498
Mailing Address - Country:US
Mailing Address - Phone:914-340-6707
Mailing Address - Fax:
Practice Address - Street 1:6975 S UNION PARK CTR
Practice Address - Street 2:
Practice Address - City:COTTONWOOD HEIGHTS
Practice Address - State:UT
Practice Address - Zip Code:84047-6048
Practice Address - Country:US
Practice Address - Phone:914-340-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist