Provider Demographics
NPI:1386735207
Name:ZULMA I FELICIANO PEREZ
Entity type:Organization
Organization Name:ZULMA I FELICIANO PEREZ
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TECNOLOGO MEDICO
Authorized Official - Prefix:MRS
Authorized Official - First Name:ZULMA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:BS MT ASCP
Authorized Official - Phone:787-871-4255
Mailing Address - Street 1:83 CALLE MUNOZ RIVERA
Mailing Address - Street 2:
Mailing Address - City:CIALES
Mailing Address - State:PR
Mailing Address - Zip Code:00638-3340
Mailing Address - Country:US
Mailing Address - Phone:787-871-4255
Mailing Address - Fax:787-871-4255
Practice Address - Street 1:83 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:CIALES
Practice Address - State:PR
Practice Address - Zip Code:00638-3340
Practice Address - Country:US
Practice Address - Phone:787-871-4255
Practice Address - Fax:787-871-4255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR343291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR30884Medicare PIN