Provider Demographics
NPI:1528718624
Name:CLINICA DE MEDICINA PRIMARIA DR WALTER F IRIZARRYCAMPERO
Entity type:Organization
Organization Name:CLINICA DE MEDICINA PRIMARIA DR WALTER F IRIZARRYCAMPERO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:F
Authorized Official - Last Name:IRIZARRY CAMPERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-385-6657
Mailing Address - Street 1:PO BOX 1602
Mailing Address - Street 2:
Mailing Address - City:LAJAS
Mailing Address - State:PR
Mailing Address - Zip Code:00667-1602
Mailing Address - Country:US
Mailing Address - Phone:787-899-1768
Mailing Address - Fax:787-899-1768
Practice Address - Street 1:65 DE INFANTERIA 7
Practice Address - Street 2:
Practice Address - City:LAJAS
Practice Address - State:PR
Practice Address - Zip Code:00667
Practice Address - Country:US
Practice Address - Phone:787-899-1768
Practice Address - Fax:787-899-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-24
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty