=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922049386
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | REBECCA A FELICIANO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2006
-----------------------------------------------------
Last Update Date | 05/21/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2129 SW 59TH ST
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73119-7024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-713-5964
-----------------------------------------------------
Fax | 405-713-4810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 269009
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73126-9009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-231-3857
-----------------------------------------------------
Fax | 405-272-7977
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 13421
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------