Provider Demographics
NPI:1295412468
Name:GONZALEZ-IRIZARRY, JOANELLY (MD)
Entity type:Individual
Prefix:
First Name:JOANELLY
Middle Name:
Last Name:GONZALEZ-IRIZARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CALLE MUNOZ RIVERA
Mailing Address - Street 2:PMB 220
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669
Mailing Address - Country:US
Mailing Address - Phone:787-486-4497
Mailing Address - Fax:
Practice Address - Street 1:2 CALLE MUNOZ RIVERA
Practice Address - Street 2:PMB 220
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669
Practice Address - Country:US
Practice Address - Phone:787-486-4497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR23429208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program