Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207L00000X | Anesthesiologist | 95035042 | CA |
Y | 207L00000X | Anesthesiologist | AP61080718 | WA |
NPI | 1003380429 |
---|---|
Provider Name | Mr. Andrew J Irizarry |
First Address | Roy, WA 98580-9105 |
Second Address | Tacoma, WA 98431-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2019 |
Last Update Date | 23/07/2020 |