Provider Demographics
NPI:1104966514
Name:FELICIANO, CARMEN OLIVA (MD)
Entity type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:OLIVA
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:AVE SAN PATRICIO
Mailing Address - Street 2:CONDOMINIO EL JARDIN 5I
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00968
Mailing Address - Country:US
Mailing Address - Phone:787-792-8823
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA ANTONIO PAOLI HF6
Practice Address - Street 2:LEVITTOWN 7MA SECCION
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-795-3535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR005458208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR005458OtherNUMERO LICCENCIA
PR2004004592OtherNUMERO REGISTRO