Provider Demographics
NPI:1366765059
Name:IRIZARRY, DIMARY (SLP MS)
Entity type:Individual
Prefix:MRS
First Name:DIMARY
Middle Name:
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:SLP MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE ISLA VERDE 2678
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:AVE ISLA VERDE 2678
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00984
Practice Address - Country:US
Practice Address - Phone:787-654-8976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2017-02-14
Deactivation Date:2014-01-09
Deactivation Code:
Reactivation Date:2017-02-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist