Provider Demographics
NPI:1528269586
Name:MARTIINEZ IRIZARRY, LORENZO (MD)
Entity type:Individual
Prefix:
First Name:LORENZO
Middle Name:
Last Name:MARTIINEZ IRIZARRY
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:URB VISTAMAR
Mailing Address - Street 2:5 A35
Mailing Address - City:GUAYAMA
Mailing Address - State:PR
Mailing Address - Zip Code:00784
Mailing Address - Country:US
Mailing Address - Phone:787-864-1680
Mailing Address - Fax:
Practice Address - Street 1:URB VISTAMAR
Practice Address - Street 2:5 A35
Practice Address - City:GUAYAMA
Practice Address - State:PR
Practice Address - Zip Code:00784
Practice Address - Country:US
Practice Address - Phone:787-864-1680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1717208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0091392Medicare ID - Type UnspecifiedMEDICARE PROVIDER