Provider Demographics
NPI:1093852626
Name:FELICIANO, JESUS
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:JESUS
Other - Middle Name:
Other - Last Name:FELICIANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:URB ISABEL LA CATOLICA CALLE 4 D-13
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602
Mailing Address - Country:US
Mailing Address - Phone:787-232-3035
Mailing Address - Fax:
Practice Address - Street 1:33 CALLE MUNOZ RIVERA W
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:PR
Practice Address - Zip Code:00677-2124
Practice Address - Country:US
Practice Address - Phone:787-823-2540
Practice Address - Fax:787-823-3183
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3417183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician