Healthcare Provider Details

I. General information

NPI: 1336131549
Provider Name (Legal Business Name): INDRA FEBLES-GORDIAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CALLE CASIA
SAN JUAN PR
00921-3200
US

IV. Provider business mailing address

COND.PLAZA REALCAPARRA #187 CARR# 2 APT#202
GUAYNABO PR
00966-1816
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-7582
  • Fax:
Mailing address:
  • Phone: 787-439-9095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11047
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: