Provider Demographics
NPI:1164893152
Name:FELICIANO, BETHZAIDA
Entity Type:Individual
Prefix:
First Name:BETHZAIDA
Middle Name:
Last Name:FELICIANO
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 1:2250 SAN VITAL DR
Mailing Address - Street 2:APT. 104 F-15
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-1572
Mailing Address - Country:US
Mailing Address - Phone:407-399-4958
Mailing Address - Fax:
Practice Address - Street 1:2250 SAN VITAL DR
Practice Address - Street 2:APT. 104 F-15
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-1572
Practice Address - Country:US
Practice Address - Phone:407-399-4958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator