Provider Demographics
NPI:1326720053
Name:FELICIANO MENDEZ, GIOMARELL (MD)
Entity Type:Individual
Prefix:
First Name:GIOMARELL
Middle Name:
Last Name:FELICIANO MENDEZ
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:HC 58 BOX 14232
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9725
Mailing Address - Country:US
Mailing Address - Phone:787-229-4717
Mailing Address - Fax:
Practice Address - Street 1:93 CALLE COLON
Practice Address - Street 2:
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602-3054
Practice Address - Country:US
Practice Address - Phone:787-589-7178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-02
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23396208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice