Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 4007 | PR |
NPI | 1013290790 |
---|---|
Provider Name | Mrs. Ana Ivette Irizarry-Toro |
First Address | San German, PR 00683-8518 |
Second Address | San German, PR 00683-8518 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2011 |
Last Update Date | 22/09/2011 |