Provider Demographics
NPI:1811440902
Name:IRIZARRY, JUAN ISAAC (MD)
Entity type:Individual
Prefix:DR
First Name:JUAN
Middle Name:ISAAC
Last Name:IRIZARRY
Suffix:
Gender:M
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:PO BOX 250482
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00604-0482
Mailing Address - Country:US
Mailing Address - Phone:787-216-2146
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL LA CONCEPCION
Practice Address - Street 2:CARR 2, KM173
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-1860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-26
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR34191R207R00000X
PR6021321390200000X
PR22586207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR34191ROtherINTERNAL MEDICINE
PR22586OtherINTERNAL MEDICINE