Provider Demographics
NPI:1700884566
Name:IRIZARRY, IVELISSE (MD)
Entity Type:Individual
Prefix:DR
First Name:IVELISSE
Middle Name:
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:IVELISSE
Other - Middle Name:
Other - Last Name:IRIZARRY ARCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1312 CALLE ALMENDRO
Mailing Address - Street 2:HACIENDA BORINQUEN
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-7527
Mailing Address - Country:US
Mailing Address - Phone:787-743-2006
Mailing Address - Fax:787-743-2006
Practice Address - Street 1:355 CALLE FONT MARTELO
Practice Address - Street 2:
Practice Address - City:HUMACAO
Practice Address - State:PR
Practice Address - Zip Code:00791-3249
Practice Address - Country:US
Practice Address - Phone:787-852-0768
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13044207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2-1031Medicare PIN
PRH66546Medicare UPIN