Provider Demographics
NPI:1174023568
Name:FELICIANO, YAHAIRA AILEEN (LND)
Entity Type:Individual
Prefix:MISS
First Name:YAHAIRA
Middle Name:AILEEN
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 1 BOX 8515
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-7415
Mailing Address - Country:US
Mailing Address - Phone:787-356-2134
Mailing Address - Fax:
Practice Address - Street 1:1551 CALLE ALDA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-2709
Practice Address - Country:US
Practice Address - Phone:787-356-2134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-13
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2030133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist