Healthcare Provider Details

I. General information

NPI: 1902721301
Provider Name (Legal Business Name): GERALDINE MAE TIRATIRA FELICIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14445 OLIVE VIEW DR
SYLMAR CA
91342-1438
US

IV. Provider business mailing address

736 SANTA FE CT
SAN DIMAS CA
91773-1843
US

V. Phone/Fax

Practice location:
  • Phone: 747-210-3066
  • Fax:
Mailing address:
  • Phone: 626-905-0214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number92515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: