Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1306 | PR |
Y | 103T00000X | Psychologist | 1306 | PR |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 10065 | DC |
NPI | 1043201239 |
---|---|
Provider Name | Dr. Victor Irizarry |
First Address | San Juan, PR 00918-3756 |
Second Address | San Juan, PR 00918-3756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2005 |
Last Update Date | 16/03/2016 |