Healthcare Provider Details

I. General information

NPI: 1033565015
Provider Name (Legal Business Name): NELSON VALENTIN FELICIANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 04/05/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CALLE HERNANDEZ CARRION, SUITE 512 MMC PROFESSIONAL PLAZA
MANATI PR
00674-0067
US

IV. Provider business mailing address

PO BOX 333
ANASCO PR
00610-0333
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-2633
  • Fax:
Mailing address:
  • Phone: 347-371-0503
  • 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 State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number240879
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: