=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578528634
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. VIDAL A FEBLES
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/19/2006
-----------------------------------------------------
Last Update Date | 11/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | PEDRO VELAZQUEZ DIAZ #628 OFIC B5
-----------------------------------------------------
City | PENUELAS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-836-0677
-----------------------------------------------------
Fax | 787-836-0677
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7443
-----------------------------------------------------
City | PONCE
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00732-7443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-836-0677
-----------------------------------------------------
Fax | 787-836-0677
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 8993
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------