Provider Demographics
NPI:1063713774
Name:RIVERA-ILARRAZA, JULIO C (MD)
Entity type:Individual
Prefix:DR
First Name:JULIO
Middle Name:C
Last Name:RIVERA-ILARRAZA
Suffix:
Gender:M
Credentials:MD
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 1890
Mailing Address - Street 2:
Mailing Address - City:LUSBY
Mailing Address - State:MD
Mailing Address - Zip Code:20657-6890
Mailing Address - Country:US
Mailing Address - Phone:410-394-0324
Mailing Address - Fax:410-394-6645
Practice Address - Street 1:13065 MILLS CREEK DR
Practice Address - Street 2:
Practice Address - City:LUSBY
Practice Address - State:MD
Practice Address - Zip Code:20657-5703
Practice Address - Country:US
Practice Address - Phone:410-394-0324
Practice Address - Fax:410-394-6645
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-11
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00231532083X0100X
PR0025542083X0100X
DCMD110812083X0100X
VA01010306362083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine