MEDICARE: DR. GLENDALIZ FELICIANO MISLA PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	5794	PR

General Provider Information

NPI Number	:	1194266916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENDALIZ FELICIANO MISLA PSYD

Provider Business Mailing Address
First Line	:	473 AVE NOEL ESTRADA
Second Line	:
City	:	ISABELA
State	:	PR
Zip	:	00662-3229
Country	:	US
Telephone Number	:	787-605-2236
Fax Number	:

Provider Business Practice Location Address
First Line	:	3361 AVE MILITAR
Second Line	:
City	:	ISABELA
State	:	PR
Zip	:	00662-4082
Country	:	US
Telephone Number	:	787-605-2236
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2017
Last Update Date	:	08/11/2020

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