Provider Demographics
NPI:1538784210
Name:FELICIANO -DE JESUS, GEISHAMARIE (DMD)
Entity type:Individual
Prefix:
First Name:GEISHAMARIE
Middle Name:
Last Name:FELICIANO -DE JESUS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CLL CORNELL
Mailing Address - Street 2:APT 402 COND UNIVERSITY GARDENS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:939-777-8851
Mailing Address - Fax:
Practice Address - Street 1:207 CLL CORNELL
Practice Address - Street 2:APT 402 COND UNIVERSITY GARDENS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:939-777-8851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program