Provider Demographics
NPI:1700176609
Name:IRIZARRY, PATRICIA ENID (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ENID
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S1 JARD FAGOT
Mailing Address - Street 2:CALLE VALERIANA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-4048
Mailing Address - Country:US
Mailing Address - Phone:787-840-3435
Mailing Address - Fax:
Practice Address - Street 1:S1 JARD FAGOT
Practice Address - Street 2:CALLE VALERIANA
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-4048
Practice Address - Country:US
Practice Address - Phone:787-840-3435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR28711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice