1104966514 NPI number — MS. CARMEN OLIVA FELICIANO MD

Table of content: MS. CARMEN OLIVA FELICIANO MD (NPI 1104966514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104966514 NPI number — MS. CARMEN OLIVA FELICIANO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELICIANO
Provider First Name:
CARMEN
Provider Middle Name:
OLIVA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1104966514
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
AVE SAN PATRICIO
Provider Second Line Business Mailing Address:
CONDOMINIO EL JARDIN 5I
Provider Business Mailing Address City Name:
GUAYNABO
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00968
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-792-8823
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVENIDA ANTONIO PAOLI HF6
Provider Second Line Business Practice Location Address:
LEVITTOWN 7MA SECCION
Provider Business Practice Location Address City Name:
TOA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-795-3535
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2007

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: 208000000X , with the licence number:  005458 , 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: 005458 . This is a "NUMERO LICCENCIA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2004004592 . This is a "NUMERO REGISTRO" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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