Provider Demographics
NPI:1932181708
Name:RODRIGUEZ-FELICIANO, GLORISSA (MD)
Entity Type:Individual
Prefix:MRS
First Name:GLORISSA
Middle Name:
Last Name:RODRIGUEZ-FELICIANO
Suffix:
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:URB. MANS DE VISTAMAR MARINA
Mailing Address - Street 2:1119 CALLE MARBELLA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983-1577
Mailing Address - Country:US
Mailing Address - Phone:939-645-4250
Mailing Address - Fax:939-337-7518
Practice Address - Street 1:1 CALLE TULIPAN BA-22
Practice Address - Street 2:VALLE ARRIBA HEIGHTS
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-1577
Practice Address - Country:US
Practice Address - Phone:787-752-6505
Practice Address - Fax:939-337-7518
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15033208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR15033OtherLICENSE