Provider Demographics
NPI:1548273113
Name:MARITZA I. IRIZARRY MD INC
Entity type:Organization
Organization Name:MARITZA I. IRIZARRY MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARITZA
Authorized Official - Middle Name:I
Authorized Official - Last Name:IRIZARRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-849-2055
Mailing Address - Street 1:5040 N 15TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-3328
Mailing Address - Country:US
Mailing Address - Phone:623-245-0505
Mailing Address - Fax:623-245-3475
Practice Address - Street 1:5040 N 15TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-3328
Practice Address - Country:US
Practice Address - Phone:623-245-0505
Practice Address - Fax:623-245-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21934208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE51177Medicare UPIN