Provider Demographics
NPI:1891672127
Name:IRIZARRY TORO, SERGIO I
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:I
Last Name:IRIZARRY TORO
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 1:11130 LOST CREEK TER APT 205
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-9370
Mailing Address - Country:US
Mailing Address - Phone:787-378-2837
Mailing Address - Fax:
Practice Address - Street 1:11130 LOST CREEK TER APT 205
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-9370
Practice Address - Country:US
Practice Address - Phone:787-378-2837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL46774390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program