Healthcare Provider Details

I. General information

NPI: 1790973444
Provider Name (Legal Business Name): LEILANI FELICIANO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 PRINTERS PKWY
COLORADO SPRINGS CO
80910-3190
US

IV. Provider business mailing address

2840 INTERNATIONAL CIR
COLORADO SPRINGS CO
80910-3127
US

V. Phone/Fax

Practice location:
  • Phone: 719-630-6440
  • Fax: 719-228-6609
Mailing address:
  • Phone: 719-630-6440
  • Fax: 719-386-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3124
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: