Provider Demographics
NPI:1851750152
Name:FELICIANO, JAVIER SR (RN)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:FELICIANO
Suffix:SR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CALLE PICAFLOR
Mailing Address - Street 2:URB. BRISAS DE CANOVANAS
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-2985
Mailing Address - Country:US
Mailing Address - Phone:787-910-3117
Mailing Address - Fax:
Practice Address - Street 1:50 CALLE PICAFLOR
Practice Address - Street 2:BRISAS DE CANOVANAS
Practice Address - City:CANOVANAS
Practice Address - State:PR
Practice Address - Zip Code:00729-2988
Practice Address - Country:US
Practice Address - Phone:787-910-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR70778 G163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse