Provider Demographics
NPI:1306380167
Name:FELICIANO FIGUEROA, JUAN GABRIEL
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:GABRIEL
Last Name:FELICIANO FIGUEROA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 CALLE ROBERTO DIAZ
Mailing Address - Street 2:URB LAS MUESAS
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-5511
Mailing Address - Country:US
Mailing Address - Phone:787-429-3121
Mailing Address - Fax:
Practice Address - Street 1:170 CALLE ROBERTO DIAZ
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-5511
Practice Address - Country:US
Practice Address - Phone:787-429-3121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-14
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
PR34921207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program