Basic Information
| Provider Information | |||||||||
| NPI: | 1427432376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FELICIANO | ||||||||
| FirstName: | GISELA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602 | ||||||||
| Address2: | |||||||||
| City: | PENUELAS | ||||||||
| State: | PR | ||||||||
| PostalCode: | 006240602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7872389380 | ||||||||
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| Practice Location | |||||||||
| Address1: | 917 AVE TITO CASTRO | ||||||||
| Address2: | HOSPITAL EPISCOPAL SAN LUCAS | ||||||||
| City: | PONCE | ||||||||
| State: | PR | ||||||||
| PostalCode: | 007164717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7878442080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2015 | ||||||||
| LastUpdateDate: | 07/09/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 32123 | PR | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.