Provider Demographics
NPI:1366222325
Name:IRIZARRY DIEZ, LAURA E
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:E
Last Name:IRIZARRY DIEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 193069
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-3069
Mailing Address - Country:US
Mailing Address - Phone:787-761-0036
Mailing Address - Fax:787-494-2072
Practice Address - Street 1:AGUADILLA SHOPPING CENTER
Practice Address - Street 2:SUITE 100
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-0091
Practice Address - Country:US
Practice Address - Phone:787-891-3087
Practice Address - Fax:787-494-2072
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist