Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME116480 | FL |
Y | 111NI0900X | Internist | ME116480 | FL |
NPI | 1003189036 |
---|---|
Provider Name | Marian Giovani Irizarry Febres |
First Address | Lutz, FL 33559-6753 |
Second Address | Lutz, FL 33559-6753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2012 |
Last Update Date | 18/08/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
107362900 | (05) | FL |