Healthcare Provider Details

I. General information

NPI: 1124248315
Provider Name (Legal Business Name): ANIBAL FELICIANO DELIZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 CALLE JOSE DE DIEGO
SAN JUAN PR
00923
US

IV. Provider business mailing address

PO BOX 29025
SAN JUAN PR
00929-0025
US

V. Phone/Fax

Practice location:
  • Phone: 787-767-5100
  • Fax:
Mailing address:
  • Phone: 787-767-5100
  • Fax: 787-250-7829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9936
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: