Basic Information
Provider Information
NPI: 1144776063
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SANTIAGO IRIZARRY
FirstName: MARISOL
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
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Mailing Information
Address1: HC 4 BOX 8730
Address2:  
City: UTUADO
State: PR
PostalCode: 006417645
CountryCode: US
TelephoneNumber: 7876507272
FaxNumber: 7877677011
Practice Location
Address1: HOSPITAL PAVIA ARECIBO
Address2: CARRETERA 129, KM 1.0 AV. SAN LUIS
City: ARECIBO
State: PR
PostalCode: 00613
CountryCode: US
TelephoneNumber: 7876507272
FaxNumber: 7877677011
Other Information
ProviderEnumerationDate: 08/31/2016
LastUpdateDate: 01/19/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: Y
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/14/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200X19258PRY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
207R00000X19258PRN Allopathic & Osteopathic PhysiciansInternal Medicine 
390200000X19,258PRN Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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