Provider Demographics
NPI:1760603179
Name:CANCEL-FELICIANO, MIREILY (MD)
Entity Type:Individual
Prefix:
First Name:MIREILY
Middle Name:
Last Name:CANCEL-FELICIANO
Suffix:
Gender:F
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:AU2 CALLE 31
Mailing Address - Street 2:TERESITA
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-8329
Mailing Address - Country:US
Mailing Address - Phone:787-780-9636
Mailing Address - Fax:
Practice Address - Street 1:AU2 CALLE 31
Practice Address - Street 2:TERESITA
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-8329
Practice Address - Country:US
Practice Address - Phone:787-780-9636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16416207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine