Basic Information
| Provider Information | |||||||||
| NPI: | 1518926237 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IRIZARRY | ||||||||
| FirstName: | RICARDO | ||||||||
| MiddleName: | ENRIQUE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2715 HYLTON AVE | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785392715 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563811443 | ||||||||
| FaxNumber: | 9562897254 | ||||||||
| Practice Location | |||||||||
| Address1: | 4701 S SUGAR RD | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785397012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9562897000 | ||||||||
| FaxNumber: | 9562897254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2006 | ||||||||
| LastUpdateDate: | 04/25/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | M1785 | TX | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | V0141096 | 01 | TX | DPS | OTHER | 8K9955 | 01 | TX | BLUE SHIELD OF TEXAS | OTHER | BI9321504 | 01 | DEA | OTHER | 176524001 | 05 | TX | MEDICAID |