Provider Demographics
NPI:1770549347
Name:FELIZ, MARCOS (MD)
Entity type:Individual
Prefix:
First Name:MARCOS
Middle Name:
Last Name:FELIZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BRAZIL ST
Mailing Address - Street 2:URB VISTA VERDE
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-855-3682
Mailing Address - Fax:787-883-6010
Practice Address - Street 1:AA 7 CARRETERA 678
Practice Address - Street 2:URB SANTA RITA
Practice Address - City:VEGA ALTA
Practice Address - State:PR
Practice Address - Zip Code:00692
Practice Address - Country:US
Practice Address - Phone:787-883-6010
Practice Address - Fax:787-883-6010
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-24
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12014208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
87963Medicare ID - Type Unspecified
G42911Medicare UPIN