Provider Demographics
NPI:1447690946
Name:BERNAL IRIZARRY, MARIELA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIELA
Middle Name:
Last Name:BERNAL IRIZARRY
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S MUSTANG RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6737
Mailing Address - Country:US
Mailing Address - Phone:405-936-5865
Mailing Address - Fax:405-936-5866
Practice Address - Street 1:520 S MUSTANG RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6737
Practice Address - Country:US
Practice Address - Phone:405-936-5865
Practice Address - Fax:405-936-5866
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR3037207Q00000X
OK44036207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3763567-01Medicaid