Provider Demographics
NPI:1356036388
Name:SANTANA IRIZARRY, GUALBERTO EMMANUEL
Entity type:Individual
Prefix:
First Name:GUALBERTO
Middle Name:EMMANUEL
Last Name:SANTANA IRIZARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 19379
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-9667
Mailing Address - Country:US
Mailing Address - Phone:787-514-8473
Mailing Address - Fax:
Practice Address - Street 1:CARR. 3101 KM. 1.2 INT.
Practice Address - Street 2:BO. LA HAYA
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667-9667
Practice Address - Country:US
Practice Address - Phone:787-514-8473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-06
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program