Provider Demographics
NPI:1083495337
Name:IRIZARRY-EGIPCIACO, MARTA TERESA (PA)
Entity type:Individual
Prefix:DR
First Name:MARTA
Middle Name:TERESA
Last Name:IRIZARRY-EGIPCIACO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:528 CESAR GONZALEZ ESQ. AVE. DOMENECH
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918
Mailing Address - Country:US
Mailing Address - Phone:787-248-0398
Mailing Address - Fax:
Practice Address - Street 1:528 AVE CESAR GONZALEZ
Practice Address - Street 2:ESQ. AVE DOMENECH
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-248-0398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-12
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1613-PA363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical