Individual
DR. MANUEL LUIS IRAVEDRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., B.S.PH
Contact information
Practice address
PO BOX PH, CHINLE, AZ 86503-8000
(928) 674-7001
Mailing address
1814 CALLE GLASGOW, COLLEGE PARK, SAN JUAN, PR 00921-4814
(787) 758-8510
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
D1388
PR
183500000X
Pharmacist
2750
PR
Other
Enumeration date
01/24/2007
Last updated
12/09/2019
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