Provider Demographics
NPI:1144263351
Name:IRIZARRY-HORNEDO, JORGE L (MD)
Entity type:Individual
Prefix:DR
First Name:JORGE
Middle Name:L
Last Name:IRIZARRY-HORNEDO
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:PO BOX 560479
Mailing Address - Street 2:
Mailing Address - City:GUAYANILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00656-0479
Mailing Address - Country:US
Mailing Address - Phone:787-873-2072
Mailing Address - Fax:787-873-2072
Practice Address - Street 1:74 CALLE ANGEL G MARTINEZ
Practice Address - Street 2:
Practice Address - City:SABANA GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00637-1718
Practice Address - Country:US
Practice Address - Phone:787-873-2072
Practice Address - Fax:787-873-2072
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14035208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0020859Medicare ID - Type Unspecified
H68428Medicare UPIN