MEDICARE: DR. WALTER FELICIANO-VELEZ 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	207R00000X	Internal Medicine Physician	14936	PR

General Provider Information

NPI Number	:	1700837796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WALTER FELICIANO-VELEZ MD

Provider Business Mailing Address
First Line	:	PO BOX 9034
Second Line	:
City	:	PONCE
State	:	PR
Zip	:	00732-9034
Country	:	US
Telephone Number	:	787-284-0109
Fax Number	:	787-284-0196

Provider Business Practice Location Address
First Line	:	2225 PONCE BY PASS
Second Line	:	EDIF. PARRA SUITE 608
City	:	PONCE
State	:	PR
Zip	:	00717-0000
Country	:	US
Telephone Number	:	787-284-0109
Fax Number	:	787-284-0196

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

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	03/19/2010

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