Provider Demographics
NPI:1922433739
Name:IRIARTE PRIMARY CARE, INC
Entity type:Organization
Organization Name:IRIARTE PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MANRIQUE
Authorized Official - Middle Name:OSCAR
Authorized Official - Last Name:IRIARTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-982-7914
Mailing Address - Street 1:429 NW 130TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-1143
Mailing Address - Country:US
Mailing Address - Phone:305-781-4815
Mailing Address - Fax:
Practice Address - Street 1:1840 W 49TH ST STE 425
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2978
Practice Address - Country:US
Practice Address - Phone:305-982-7914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-11
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116904207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty