Healthcare Provider Details

I. General information

NPI: 1306205919
Provider Name (Legal Business Name): MARIA ACEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2016
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14761 MCVAY AVE
SAN JOSE CA
95127-2539
US

IV. Provider business mailing address

14761 MCVAY AVE
SAN JOSE CA
95127-2539
US

V. Phone/Fax

Practice location:
  • Phone: 408-926-1599
  • Fax: 408-521-0926
Mailing address:
  • Phone: 408-926-1599
  • Fax: 408-521-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171R00000X
TaxonomyInterpreter
License Number500009
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: