1528224938 NPI number — VISION 4 YOU CLINICA VISUAL DRA. FELICIANO CSP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528224938 NPI number — VISION 4 YOU CLINICA VISUAL DRA. FELICIANO CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISION 4 YOU CLINICA VISUAL DRA. FELICIANO CSP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528224938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE LOIRE # 43 VILLA SERENA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ISABEL
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-845-5278
Provider Business Mailing Address Fax Number:
787-558-7034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
809 CARR. 153 STE 7 LOCAL PLAZA
Provider Second Line Business Practice Location Address:
BO. PASO SECO
Provider Business Practice Location Address City Name:
SANTA ISABEL
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-845-5278
Provider Business Practice Location Address Fax Number:
787-558-7034
Provider Enumeration Date:
08/05/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROMAN
Authorized Official First Name:
HELBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
787-402-1906

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  295-003 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: 295003 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 295-003 . This is a "LICENSE" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 58086 . This is a "TRIPLE-S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".