Provider Demographics
NPI:1578528634
Name:FEBLES, VIDAL A
Entity Type:Individual
Prefix:DR
First Name:VIDAL
Middle Name:A
Last Name:FEBLES
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:PO BOX 7443
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7443
Mailing Address - Country:US
Mailing Address - Phone:787-836-0677
Mailing Address - Fax:787-836-0677
Practice Address - Street 1:PEDRO VELAZQUEZ DIAZ
Practice Address - Street 2:#628 OFIC B5
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-836-0677
Practice Address - Fax:787-836-0677
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8993207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E81687Medicare UPIN
0081407Medicare ID - Type Unspecified