MEDICARE: DR. JACKELINE FELICIANO ECHEVARRIA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	22975	PR

General Provider Information

NPI Number	:	1659091296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JACKELINE FELICIANO ECHEVARRIA MD

Provider Business Mailing Address
First Line	:	PO BOX 427
Second Line	:
City	:	JUANA DIAZ
State	:	PR
Zip	:	00795-0427
Country	:	US
Telephone Number	:	939-217-9853
Fax Number	:

Provider Business Practice Location Address
First Line	:	17 CALLE MUNOZ RIVERA
Second Line	:
City	:	VILLALBA
State	:	PR
Zip	:	00766-2228
Country	:	US
Telephone Number	:	787-847-2441
Fax Number	:	787-847-2441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2022
Last Update Date	:	09/01/2022

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