Provider Demographics
NPI:1053599175
Name:CONSULTORIO MEDICO DR. JOSE A. ACEVEDO PSC
Entity type:Organization
Organization Name:CONSULTORIO MEDICO DR. JOSE A. ACEVEDO PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANGEL
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-891-5663
Mailing Address - Street 1:BORINQUEN PLZ
Mailing Address - Street 2:URB. VILLA HAYDEE # 10
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-5970
Mailing Address - Country:US
Mailing Address - Phone:787-891-5663
Mailing Address - Fax:787-891-5663
Practice Address - Street 1:CARR 107 # KM 2/7
Practice Address - Street 2:URB. VILLA HAYDEE # 10
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5970
Practice Address - Country:US
Practice Address - Phone:787-891-5663
Practice Address - Fax:787-891-5663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12380261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRH35842Medicare UPIN