Provider Demographics
NPI:1417629619
Name:FELICIANO, ALEX DANIEL
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:DANIEL
Last Name:FELICIANO
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:HC 3 BOX 15631
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-9833
Mailing Address - Country:US
Mailing Address - Phone:787-508-6424
Mailing Address - Fax:
Practice Address - Street 1:BO BARINAS CARRETERA 335 KILOMETRO 1.6
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-856-7284
Practice Address - Fax:787-267-1011
Is Sole Proprietor?:No
Enumeration Date:2021-10-05
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist