MEDICARE: MRS. MARIA M ACEVEDO TORAL RD

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	133VN1005X	Renal Nutrition Registered Dietitian	13369	PR
2	133V00000X	Registered Dietitian	1336	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1336	OTHER	PR	JUNTA DE PROFESIONALES DE SALUD DE PR

General Provider Information

NPI Number	:	1265625578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA M ACEVEDO TORAL RD

Provider Business Mailing Address
First Line	:	PO BOX 51502
Second Line	:
City	:	TOA BAJA
State	:	PR
Zip	:	00950-1502
Country	:	US
Telephone Number	:	787-710-2532
Fax Number	:

Provider Business Practice Location Address
First Line	:	140 AVE LAS CUMBRES
Second Line	:	GUAYNABO MEDICAL MALL LOCAL B
City	:	GUAYNABO
State	:	PR
Zip	:	00969-5523
Country	:	US
Telephone Number	:	787-710-2532
Fax Number	:

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

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	12/10/2019

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