Provider Demographics
NPI:1841843141
Name:SERPA IRIZARRY, ALEXANDRA MARIA
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARIA
Last Name:SERPA IRIZARRY
Suffix:
Gender:F
Credentials:
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 9235
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-9235
Mailing Address - Country:US
Mailing Address - Phone:304-293-3091
Mailing Address - Fax:
Practice Address - Street 1:HOSPITAL EPISCOPAL SAN LUCAS
Practice Address - Street 2:917 AVENIDA TITO CASTTO
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-844-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program