Healthcare Provider Details

I. General information

NPI: 1841116720
Provider Name (Legal Business Name): JESUS M FELICIANO ROSADO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE JUAN SAN ANTONIO EDIFICIO 207 BO. PUEBLO
MOCA PR
00676
US

IV. Provider business mailing address

HC 3 BOX 91061
SAN GERMAN PR
00683
US

V. Phone/Fax

Practice location:
  • Phone: 787-818-0100
  • Fax:
Mailing address:
  • Phone: 787-717-7919
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number402
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number402
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: