Provider Demographics
NPI:1871582890
Name:CASTRO IRIZARRY, EFRAIN
Entity type:Individual
Prefix:
First Name:EFRAIN
Middle Name:
Last Name:CASTRO 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:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1114
Mailing Address - Country:US
Mailing Address - Phone:787-892-7690
Mailing Address - Fax:787-892-7690
Practice Address - Street 1:SAN GERMAN MEDICAL PLAZA, SUITE 203
Practice Address - Street 2:CARR #2 KM 174.3
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-892-7690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000090213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRU44278Medicare UPIN