Provider Demographics
NPI:1205149671
Name:ANDINO FELICIANO, GIOVANNI (LND)
Entity type:Individual
Prefix:MR
First Name:GIOVANNI
Middle Name:
Last Name:ANDINO FELICIANO
Suffix:
Gender:M
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 23 BOX 6156
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-9790
Mailing Address - Country:US
Mailing Address - Phone:787-554-6677
Mailing Address - Fax:
Practice Address - Street 1:HC 23 BOX 6156
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777-9790
Practice Address - Country:US
Practice Address - Phone:787-554-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1577133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered