Provider Demographics
NPI:1538681655
Name:BELTRAN FELICIANO, EDRICK (MD)
Entity Type:Individual
Prefix:
First Name:EDRICK
Middle Name:
Last Name:BELTRAN FELICIANO
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 1:2008 CALLE PRIMAVERA
Mailing Address - Street 2:URB ELIZABETH
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623
Mailing Address - Country:US
Mailing Address - Phone:787-932-2974
Mailing Address - Fax:
Practice Address - Street 1:2008 CALLE PRIMAVERA
Practice Address - Street 2:URB ELIZABETH
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623
Practice Address - Country:US
Practice Address - Phone:787-932-2974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19723208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice