Healthcare Provider Details

I. General information

NPI: 1346952868
Provider Name (Legal Business Name): MR. JULIO A ADORNO FELICIANO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2022
Last Update Date: 11/12/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AVENIDA AGUSTIN RAMOS CALERO INTERIOR CARR. 112 KM 1.4
ISABELA PR
00662-0737
US

IV. Provider business mailing address

URB PASEOS REALES 251 CALLE SEGOBIA
SAN ANTONIO PR
00690
US

V. Phone/Fax

Practice location:
  • Phone: 939-200-7103
  • Fax: 787-832-0740
Mailing address:
  • Phone: 939-200-7103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15971
License Number StatePR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: