Provider Demographics
NPI:1508963075
Name:FELIU, LUIS EDWIN (PA)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:EDWIN
Last Name:FELIU
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 MEDICAL CENTER DR STE 400
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5000
Mailing Address - Country:US
Mailing Address - Phone:915-546-9200
Mailing Address - Fax:915-546-9800
Practice Address - Street 1:1626 MEDICAL CENTER DR STE 400
Practice Address - Street 2:4TH FLOOR
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5000
Practice Address - Country:US
Practice Address - Phone:915-546-9200
Practice Address - Fax:915-546-9800
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03666363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193595901Medicaid
TX193595902Medicaid
NM47924233Medicaid
TX193595901Medicaid
TX8J0415Medicare ID - Type Unspecified
TX193595902Medicaid