Healthcare Provider Details

I. General information

NPI: 1922049386
Provider Name (Legal Business Name): REBECCA A FELICIANO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2129 SW 59TH ST
OKLAHOMA CITY OK
73119-7024
US

IV. Provider business mailing address

PO BOX 269009
OKLAHOMA CITY OK
73126-9009
US

V. Phone/Fax

Practice location:
  • Phone: 405-713-5964
  • Fax: 405-713-4810
Mailing address:
  • Phone: 405-231-3857
  • Fax: 405-272-7977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number13421
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: