Healthcare Provider Details

I. General information

NPI: 1710980297
Provider Name (Legal Business Name): MANUEL R URBISTONDO-FELICIANO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDIF WINSTON CHURCHILL 2000 200 AVE W/CHURCHILL SUITE 201
SAN JUAN PR
00926
US

IV. Provider business mailing address

CALL BOX 7886 PMB 367
GUAYNABO PR
00970-7886
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-1039
  • Fax: 787-765-6197
Mailing address:
  • Phone: 787-765-1039
  • Fax: 787-765-6197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number11833
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: