Healthcare Provider Details

I. General information

NPI: 1215250147
Provider Name (Legal Business Name): ZULMA I FELICIANO BS,MT,ASCP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2010
Last Update Date: 03/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 CALLE MUNOZ RIVERA # B
CIALES PR
00638-3340
US

IV. Provider business mailing address

83 CALLE MUNOZ RIVERA # B
CIALES PR
00638-3340
US

V. Phone/Fax

Practice location:
  • Phone: 787-871-4255
  • Fax: 787-871-4255
Mailing address:
  • Phone: 787-871-4255
  • Fax: 787-871-4255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number2442
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: