Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3571 | PR |
Y | 103T00000X | Psychologist | 3571 | PR |
NPI | 1003204579 |
---|---|
Provider Name | Tayliss Irizarry |
First Address | San German, PR 00683-2529 |
Second Address | San German, PR 00683-2529 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2015 |
Last Update Date | 06/01/2015 |