Provider Demographics
NPI:1306434428
Name:IZQUIERDO, JASON LUIS (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:LUIS
Last Name:IZQUIERDO
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:HC 43 BOX 11763
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-9226
Mailing Address - Country:US
Mailing Address - Phone:787-385-5349
Mailing Address - Fax:
Practice Address - Street 1:BO HODURAS CARR 14
Practice Address - Street 2:
Practice Address - City:CIDRA
Practice Address - State:PR
Practice Address - Zip Code:00736-9226
Practice Address - Country:US
Practice Address - Phone:787-385-5349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program