Healthcare Provider Details

I. General information

NPI: 1306380167
Provider Name (Legal Business Name): JUAN GABRIEL FELICIANO FIGUEROA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2016
Last Update Date: 07/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 CALLE ROBERTO DIAZ
CAYEY PR
00736-5511
US

IV. Provider business mailing address

170 CALLE ROBERTO DIAZ URB LAS MUESAS
CAYEY PR
00736-5511
US

V. Phone/Fax

Practice location:
  • Phone: 787-429-3121
  • Fax:
Mailing address:
  • Phone: 787-429-3121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34921
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: