Provider Demographics
NPI:1700837796
Name:FELICIANO-VELEZ, WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:FELICIANO-VELEZ
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:PO BOX 9034
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-9034
Mailing Address - Country:US
Mailing Address - Phone:787-284-0109
Mailing Address - Fax:787-284-0196
Practice Address - Street 1:2225 PONCE BY PASS
Practice Address - Street 2:EDIF. PARRA SUITE 608
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0000
Practice Address - Country:US
Practice Address - Phone:787-284-0109
Practice Address - Fax:787-284-0196
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR24239Medicare ID - Type Unspecified
PRI56504Medicare UPIN