Provider Demographics
NPI:1811662356
Name:IRIZARRY RIVERA, BLANCA MARIE (MD)
Entity type:Individual
Prefix:
First Name:BLANCA
Middle Name:MARIE
Last Name:IRIZARRY RIVERA
Suffix:
Gender:F
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 2496
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-2496
Mailing Address - Country:US
Mailing Address - Phone:939-992-9322
Mailing Address - Fax:
Practice Address - Street 1:CENTRO PROFESIONAL DEL SUR
Practice Address - Street 2:1100 CARR 116 STE 2
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-4693
Practice Address - Country:US
Practice Address - Phone:939-992-9322
Practice Address - Fax:939-992-9326
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-16
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22489208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice