Provider Demographics
NPI:1407001415
Name:MARLENNY FELIZ MD PA
Entity type:Organization
Organization Name:MARLENNY FELIZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARLENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:FELIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-322-8985
Mailing Address - Street 1:PO BOX 260715
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-7715
Mailing Address - Country:US
Mailing Address - Phone:954-322-8985
Mailing Address - Fax:
Practice Address - Street 1:1613 N HIATUS RD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33026-2129
Practice Address - Country:US
Practice Address - Phone:954-885-6565
Practice Address - Fax:754-400-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 96474207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000733500Medicaid