Provider Demographics
NPI:1871241497
Name:FELIZ CARRASCO, LEIDY LAURA (MD)
Entity Type:Individual
Prefix:DR
First Name:LEIDY
Middle Name:LAURA
Last Name:FELIZ CARRASCO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEIDY
Other - Middle Name:LAURA
Other - Last Name:FELIZ CARRASCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:375 CALLE ALFREDO CARBONELL
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-2316
Mailing Address - Country:US
Mailing Address - Phone:787-329-2765
Mailing Address - Fax:
Practice Address - Street 1:CARR. #5 AVE. CENTRAL JUANITA FINAL
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:939-225-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000032363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical