Provider Demographics
NPI:1023871449
Name:FELICIANO, JULIO JOEL SR (PA)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:JOEL
Last Name:FELICIANO
Suffix:SR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13521 N 127TH DR
Mailing Address - Street 2:
Mailing Address - City:EL MIRAGE
Mailing Address - State:AZ
Mailing Address - Zip Code:85335-5347
Mailing Address - Country:US
Mailing Address - Phone:939-209-3703
Mailing Address - Fax:
Practice Address - Street 1:13521 N 127TH DR
Practice Address - Street 2:
Practice Address - City:EL MIRAGE
Practice Address - State:AZ
Practice Address - Zip Code:85335-5347
Practice Address - Country:US
Practice Address - Phone:939-209-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-31
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10154363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical