Healthcare Provider Details

I. General information

NPI: 1548724214
Provider Name (Legal Business Name): RAQUEL MONIQUE VICARIO FELICIANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 SOUTHERN BLVD STE 2000
KETTERING OH
45429-1285
US

IV. Provider business mailing address

PO BOX 193353
SAN JUAN PR
00919-3353
US

V. Phone/Fax

Practice location:
  • Phone: 937-228-4126
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35.156384
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: