Healthcare Provider Details

I. General information

NPI: 1306380316
Provider Name (Legal Business Name): JOEL FELICIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PRISON RD
REPRESA CA
95671-3001
US

IV. Provider business mailing address

2725 STONECREEK DR
SACRAMENTO CA
95833-1990
US

V. Phone/Fax

Practice location:
  • Phone: 916-985-2561
  • Fax:
Mailing address:
  • Phone: 916-550-5481
  • Fax: 916-822-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number113742
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113742
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: