Provider Demographics
NPI:1528623907
Name:IRIZARRY, BOBBIEJO (LPN)
Entity type:Individual
Prefix:
First Name:BOBBIEJO
Middle Name:
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1019 FREDERICK CT
Mailing Address - Street 2:
Mailing Address - City:CANONSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15317-9711
Mailing Address - Country:US
Mailing Address - Phone:724-503-7639
Mailing Address - Fax:
Practice Address - Street 1:645 RODI RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15235-4564
Practice Address - Country:US
Practice Address - Phone:412-723-2775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN258253L164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse