Provider Demographics
NPI:1205192564
Name:FELICIANO, ELIA ROXANA (LND)
Entity Type:Individual
Prefix:
First Name:ELIA
Middle Name:ROXANA
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:PO BOX 1750
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00681-1750
Mailing Address - Country:US
Mailing Address - Phone:787-834-6000
Mailing Address - Fax:787-831-6315
Practice Address - Street 1:AVE HOSTOS 770
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-0000
Practice Address - Country:US
Practice Address - Phone:787-834-6161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR001379133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered