Provider Demographics
NPI:1720617152
Name:IRIZARRY, JOSE JUAN
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:JUAN
Last Name: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:D-14 CALLE PARKSIDE 6 CONDOMINIO PARKSIDE
Mailing Address - Street 2:APT 604
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968-3316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:D-14 CALLE PARKSIDE 6 CONDOMINIO PARKSIDE
Practice Address - Street 2:APT 604
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00968-3316
Practice Address - Country:US
Practice Address - Phone:787-479-4450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23787207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine