Provider Demographics
NPI:1538751904
Name:IRIZARRY-BONILLA, ANDREA P (DC)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:P
Last Name:IRIZARRY-BONILLA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 URB SAN RAMON
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-4604
Mailing Address - Country:US
Mailing Address - Phone:787-519-6849
Mailing Address - Fax:
Practice Address - Street 1:YAUCO GALLERY CARR 128 KM 2.2 BARRIO SUSUA BAJA
Practice Address - Street 2:SUITE 7
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-4431
Practice Address - Country:US
Practice Address - Phone:787-519-6849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-08
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000936111N00000X
TX14503111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty