Provider Demographics
NPI:1073074357
Name:FELICIANO FIGUEROA, WILMER ENRIQUE
Entity Type:Individual
Prefix:
First Name:WILMER
Middle Name:ENRIQUE
Last Name:FELICIANO FIGUEROA
Suffix:
Gender:M
Credentials:
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 365067
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-5067
Mailing Address - Country:US
Mailing Address - Phone:787-765-5184
Mailing Address - Fax:
Practice Address - Street 1:RECINTO DE CIENCIAS MEDICAS EDIFICIO PRINCIPAL
Practice Address - Street 2:DEPARTAMENTO DE CIRUGIA FLOOR 9 OFFICE A923
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00925
Practice Address - Country:US
Practice Address - Phone:787-765-5184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PR22985208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program