Provider Demographics
NPI:1497529812
Name:FELICIANO, SOFIA B (DNP)
Entity Type:Individual
Prefix:
First Name:SOFIA
Middle Name:B
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30141 ANTELOPE RD STE D
Mailing Address - Street 2:#1208
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-8066
Mailing Address - Country:US
Mailing Address - Phone:951-595-7130
Mailing Address - Fax:
Practice Address - Street 1:25220 HANCOCK AVE STE 100
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-0901
Practice Address - Country:US
Practice Address - Phone:951-663-6746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95170492163W00000X
CA95026429363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse