1083784904 NPI number — DR. BRISEIDA ENID FELICIANO M.D.

Table of content: DR. BRISEIDA ENID FELICIANO M.D. (NPI 1083784904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083784904 NPI number — DR. BRISEIDA ENID FELICIANO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELICIANO
Provider First Name:
BRISEIDA
Provider Middle Name:
ENID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1083784904
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8818
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00726-8818
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
178-770-3392
Provider Business Mailing Address Fax Number:
178-770-3390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
V28 AVE LUIS MUNOZ MARIN
Provider Second Line Business Practice Location Address:
URB. MARIOLGA
Provider Business Practice Location Address City Name:
CAGUAS
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00725-6462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
178-770-3392
Provider Business Practice Location Address Fax Number:
178-770-3390
Provider Enumeration Date:
11/08/2006

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: 2084N0400X , with the licence number:  9525 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084N0600X , with the licence number: 9525 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 069484 . This is a "CRUZ AZUL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 82821FE . This is a "TRIPLE S" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 217031 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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