1477901841 NPI number — DR. DARIEL J IRIZARRY DE JESUS M.D.

Table of content: (NPI 1730204785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477901841 NPI number — DR. DARIEL J IRIZARRY DE JESUS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IRIZARRY DE JESUS
Provider First Name:
DARIEL
Provider Middle Name:
J
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:
1477901841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 EXT VILLA MILAGROS
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CABO ROJO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00623-4453
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-538-3488
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2225 PONCE BYP STE 407
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PONCE
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00717-1322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-840-8686
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2016

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: 207RI0200X , with the licence number:  22663 , 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)





Copyright © 2007-2025 www.npivalidator.com