Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 1345 | PR |
NPI | 1003809120 |
---|---|
Provider Name | Dr. Lourdes Feliciano-Nieves |
First Address | San Juan, PR 00919-4817 |
Second Address | San Juan, PR 00918 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 06/05/2020 |