Healthcare Provider Details

I. General information

NPI: 1689735524
Provider Name (Legal Business Name): EDGARDO TARAFA FELICIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CALLE SAN RAFAEL
SAN JUAN PR
00909-2518
US

IV. Provider business mailing address

PO BOX 2328
MANATI PR
00674-2328
US

V. Phone/Fax

Practice location:
  • Phone: 787-999-7620
  • Fax:
Mailing address:
  • Phone: 787-648-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14021
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: