Provider Demographics
NPI:1750923439
Name:FELICIANO, DENISE
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:FELICIANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2031 REPARTO DE ALTURAS 1
Mailing Address - Street 2:
Mailing Address - City:PENUELAS
Mailing Address - State:PR
Mailing Address - Zip Code:00624
Mailing Address - Country:US
Mailing Address - Phone:787-617-8142
Mailing Address - Fax:
Practice Address - Street 1:ALTURAS DE PENUELAS 1
Practice Address - Street 2:CALLE 8 CASA C-7
Practice Address - City:PENUELAS
Practice Address - State:PR
Practice Address - Zip Code:00624
Practice Address - Country:US
Practice Address - Phone:787-617-8142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR88310163W00000X, 163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
4571498OtherLICENCIA
PR4571498OtherLICENCIA