Healthcare Provider Details

I. General information

NPI: 1356847552
Provider Name (Legal Business Name): JESSICA DOMINIQUE FELIZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 WESTFORD ST STE 2
LOWELL MA
01851-2853
US

IV. Provider business mailing address

1115 WESTFORD ST STE 2
LOWELL MA
01851-2853
US

V. Phone/Fax

Practice location:
  • Phone: 351-221-7080
  • Fax:
Mailing address:
  • Phone: 351-221-7080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number287312
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: