Provider Demographics
NPI:1922049386
Name:FELICIANO, REBECCA A (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:A
Last Name: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:PO BOX 269009
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73126-9009
Mailing Address - Country:US
Mailing Address - Phone:405-231-3857
Mailing Address - Fax:405-272-7977
Practice Address - Street 1:2129 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7024
Practice Address - Country:US
Practice Address - Phone:405-713-5964
Practice Address - Fax:405-713-4810
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK134212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100210910AMedicaid
OK100210910AMedicaid
OKD34628Medicare UPIN
OK249416603Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL ID