Provider Demographics
NPI:1033978937
Name:FELICIANO RIVERA, VILMA RUT
Entity Type:Individual
Prefix:
First Name:VILMA
Middle Name:RUT
Last Name:FELICIANO RIVERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4364 CALLE GIMNASIA
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-3700
Mailing Address - Country:US
Mailing Address - Phone:281-701-3682
Mailing Address - Fax:
Practice Address - Street 1:4364 CALLE GIMNASIA
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-3700
Practice Address - Country:US
Practice Address - Phone:281-701-3682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-14
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001605363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant