=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275441776
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSE FELIX
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2026
-----------------------------------------------------
Last Update Date | 08/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PO BOX 421
-----------------------------------------------------
City | PAYETTE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83661-0421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-405-0020
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4735 HIGHWAY 30 S
-----------------------------------------------------
City | NEW PLYMOUTH
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83655-5310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-297-9355
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------