Provider Demographics
NPI:1659421980
Name:FELICIANO, ELSA ENID (2129)
Entity Type:Individual
Prefix:MRS
First Name:ELSA
Middle Name:ENID
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:2129
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CALLE ROMAN
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-2929
Mailing Address - Country:US
Mailing Address - Phone:787-872-2630
Mailing Address - Fax:787-872-2630
Practice Address - Street 1:100 CALLE ROMAN
Practice Address - Street 2:
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662-2929
Practice Address - Country:US
Practice Address - Phone:787-872-2630
Practice Address - Fax:787-872-2630
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2129183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist