Provider Demographics
NPI:1396785580
Name:FELICIANO, RUTH MIRIAM I (MD)
Entity type:Individual
Prefix:DR
First Name:RUTH
Middle Name:MIRIAM
Last Name:FELICIANO
Suffix:I
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 1:2005 AVE SAGRADO CRZN
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00915-3333
Mailing Address - Country:US
Mailing Address - Phone:787-649-6490
Mailing Address - Fax:
Practice Address - Street 1:2005 AVE SAGRADO CRZN
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00915-3333
Practice Address - Country:US
Practice Address - Phone:787-649-6490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR105582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry