Provider Demographics
NPI:1063188282
Name:DR FELICIANO PRIMARY HEALTHCARE PROVIDER PSC
Entity type:Organization
Organization Name:DR FELICIANO PRIMARY HEALTHCARE PROVIDER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AFORTUNADO
Authorized Official - Middle Name:
Authorized Official - Last Name:FELICIANO MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-974-7878
Mailing Address - Street 1:PO BOX 1477
Mailing Address - Street 2:
Mailing Address - City:OROCOVIS
Mailing Address - State:PR
Mailing Address - Zip Code:00720-1477
Mailing Address - Country:US
Mailing Address - Phone:787-867-2208
Mailing Address - Fax:
Practice Address - Street 1:16 CALLE 4 DE JULIO
Practice Address - Street 2:
Practice Address - City:OROCOVIS
Practice Address - State:PR
Practice Address - Zip Code:00720-4498
Practice Address - Country:US
Practice Address - Phone:787-867-2208
Practice Address - Fax:787-633-6696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty