Basic Information
Provider Information | |||||||||
NPI: | 1144776063 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SANTIAGO IRIZARRY | ||||||||
FirstName: | MARISOL | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
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: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/14/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 19258 | PR | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207R00000X | 19258 | PR | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 390200000X | 19,258 | PR | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   |
No ID Information.