Provider Demographics
NPI:1962218727
Name:IRIZARRY, ASTRID E
Entity type:Individual
Prefix:DR
First Name:ASTRID
Middle Name:E
Last Name:IRIZARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 AVE LA SIERRA # 3102
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4344
Mailing Address - Country:US
Mailing Address - Phone:939-788-0941
Mailing Address - Fax:
Practice Address - Street 1:120 AVE LA SIERRA # 3102
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-4344
Practice Address - Country:US
Practice Address - Phone:939-788-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR008171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical