Healthcare Provider Details

I. General information

NPI: 1134150618
Provider Name (Legal Business Name): CELIADE LOURDES FELICIANO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PLAZA SANTA ISABEL #9
SANTA ISABEL PR
00757
US

IV. Provider business mailing address

LOIRE 43 VILLA SERONA
SANTA ISABEL PR
00757
US

V. Phone/Fax

Practice location:
  • Phone: 787-845-5278
  • Fax: 787-558-7034
Mailing address:
  • Phone: 787-845-5278
  • Fax: 787-558-7034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0295
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: