1013971712 NPI number — MR. WILLIAM FELICIANO M.D.

Table of content: MR. WILLIAM FELICIANO M.D. (NPI 1013971712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013971712 NPI number — MR. WILLIAM FELICIANO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELICIANO
Provider First Name:
WILLIAM
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1013971712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
42 CALLE YAGRUMO
Provider Second Line Business Mailing Address:
CIUDAD JARDIN III
Provider Business Mailing Address City Name:
TOA ALTA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00953-4867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-730-7763
Provider Business Mailing Address Fax Number:
787-779-8491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BAYAMON MEDICAL MALL
Provider Second Line Business Practice Location Address:
SUITE 708
Provider Business Practice Location Address City Name:
BAYAMON
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00959-7200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-787-5813
Provider Business Practice Location Address Fax Number:
787-779-8491
Provider Enumeration Date:
04/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  4102 , 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: 3404102 . This is a "U.I.A." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6745 . This is a "FIRST MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6200091 . This is a "HUMANA HEALTH PLAN" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 6200091 . This is a "HUMANA INS." identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 825623 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 24829FE . This is a "TRIPLE-S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 063458 . This is a "BLUE CROSS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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