MEDICARE: DR. MANUEL R URBISTONDO-FELICIANO M.D.

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	207RG0100X	Gastroenterology Physician	11833	PR

General Provider Information

NPI Number	:	1710980297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL R URBISTONDO-FELICIANO M.D.

Provider Business Mailing Address
First Line	:	CALL BOX 7886 PMB 367
Second Line	:
City	:	GUAYNABO
State	:	PR
Zip	:	00970-7886
Country	:	US
Telephone Number	:	787-765-1039
Fax Number	:	787-765-6197

Provider Business Practice Location Address
First Line	:	EDIF WINSTON CHURCHILL 2000
Second Line	:	200 AVE W/CHURCHILL SUITE 201
City	:	SAN JUAN
State	:	PR
Zip	:	00926
Country	:	US
Telephone Number	:	787-765-1039
Fax Number	:	787-765-6197

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

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	07/31/2007

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