Provider Demographics
NPI:1942500855
Name:PLAZA DE LA SALUD PLLC
Entity Type:Organization
Organization Name:PLAZA DE LA SALUD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FELICIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-314-4600
Mailing Address - Street 1:2635 BOGGY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4101
Mailing Address - Country:US
Mailing Address - Phone:239-314-4600
Mailing Address - Fax:
Practice Address - Street 1:2635 BOGGY CREEK RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4101
Practice Address - Country:US
Practice Address - Phone:239-314-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105191261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDE030YOtherMEDICARE PTAN DR FELICIANO
FLEZ306AOtherMEDICARE PTAN PLAZA DE LA SALUD
FL1942283429OtherDR GERARDO FELICIANO NPI
FL4240180OtherCIGNA
FLDE030YOtherTRICARE
E47806Medicare UPIN