Provider Demographics
NPI:1629958160
Name:IRIZARRY, ANGEL M
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:M
Last Name:IRIZARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 6040
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-9457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BARRIO SIERRA BAJA
Practice Address - Street 2:CARR 378 KM 4.7
Practice Address - City:GUAYANILLA
Practice Address - State:PR
Practice Address - Zip Code:00656-9457
Practice Address - Country:US
Practice Address - Phone:787-543-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR92814-G163WC1400X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health
No163W00000XNursing Service ProvidersRegistered Nurse