1376710988 NPI number — DR. RICARDO OMAR DIAZ IRIZARRY M.D

Table of content: DR. RICARDO OMAR DIAZ IRIZARRY M.D (NPI 1376710988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376710988 NPI number — DR. RICARDO OMAR DIAZ IRIZARRY M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIAZ IRIZARRY
Provider First Name:
RICARDO
Provider Middle Name:
OMAR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376710988
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 277
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYAMON
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00960-0277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-501-5724
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
URB. LOMAS VERDES
Provider Second Line Business Practice Location Address:
2Z3 JACINTO
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-501-5724
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 146D00000X , with the licence number:  17131 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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