Provider Demographics
NPI:1871888149
Name:IRIZARRY, JELISABEL
Entity type:Individual
Prefix:
First Name:JELISABEL
Middle Name:
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANSIONES MONTE VERDE
Mailing Address - Street 2:238
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-4170
Mailing Address - Country:US
Mailing Address - Phone:787-900-3733
Mailing Address - Fax:
Practice Address - Street 1:MANS. MONTE VERDE
Practice Address - Street 2:238
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4170
Practice Address - Country:US
Practice Address - Phone:787-900-3733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist