Provider Demographics
NPI:1235343609
Name:FELIZ-LEBREAULT, VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:
Last Name:FELIZ-LEBREAULT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:K-3, COND VILLAS DE PLAYA 2
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-615-7808
Mailing Address - Fax:787-767-3968
Practice Address - Street 1:HOSPITAL INDUSTRIAL-CENTRO MEDICO
Practice Address - Street 2:BO. MONACILLOS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00936
Practice Address - Country:US
Practice Address - Phone:787-754-2525
Practice Address - Fax:787-767-3968
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR44411OtherSTATE LICENSE