Provider Demographics
NPI:1124248315
Name:FELICIANO DELIZ, ANIBAL (MD)
Entity type:Individual
Prefix:
First Name:ANIBAL
Middle Name:
Last Name:FELICIANO DELIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 29025
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00929-0025
Mailing Address - Country:US
Mailing Address - Phone:787-767-5100
Mailing Address - Fax:787-250-7829
Practice Address - Street 1:371 CALLE JOSE DE DIEGO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00923
Practice Address - Country:US
Practice Address - Phone:787-767-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-27
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081985Medicare PIN
PRE63403Medicare UPIN