MEDICARE: DR. VIDAL A FEBLES

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	207R00000X	Internal Medicine Physician	8993	PR

General Provider Information

NPI Number	:	1578528634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIDAL A FEBLES

Provider Business Mailing Address
First Line	:	PO BOX 7443
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-7443
Country	:	US
Telephone Number	:	787-836-0677
Fax Number	:	787-836-0677

Provider Business Practice Location Address
First Line	:	PEDRO VELAZQUEZ DIAZ
Second Line	:	#628 OFIC B5
City	:	PENUELAS
State	:	PR
Zip	:	00624
Country	:	US
Telephone Number	:	787-836-0677
Fax Number	:	787-836-0677

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	11/16/2010

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