Provider Demographics
NPI:1942283429
Name:FELICIANO-VASQUEZ, GERARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:FELICIANO-VASQUEZ
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 1:3502 MOLONA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-5828
Mailing Address - Country:US
Mailing Address - Phone:407-300-2936
Mailing Address - Fax:
Practice Address - Street 1:3502 MOLONA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-5828
Practice Address - Country:US
Practice Address - Phone:407-300-2936
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301071373207R00000X
FLME105191207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N985000011OtherMEDICARE ADVANTAGE
MI104953941Medicaid
FLDE030Y OFFICE PRACTOtherMEDICARE PTAN
MI025020OtherMIDWEST HEALTH PLAN
FL148P1OtherBC/BS
FLDE030YOtherMEDICARE PTAN PLAZA DE LA SALUD OFFICE
MI110H229590OtherBCBS
FLDE030ZOtherMEDICARE PTAN
FL002278300Medicaid
MI201340828OtherGREAT WEST HEALTH CARE
MI8042OtherTOTAL HEALTH CARE
MI8042OtherTOTAL HEALTH CARE
MIE47806Medicare UPIN