Healthcare Provider Details

I. General information

NPI: 1629355177
Provider Name (Legal Business Name): MR. DOMINIC JOSEPH ACEVEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2011
Last Update Date: 06/30/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 ARLINGTON DR. SAN LEANDRO
SAN LEANDRO CA
94578
US

IV. Provider business mailing address

124 RIVER RD
SALINAS CA
93908-9601
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-1222
  • Fax:
Mailing address:
  • Phone: 831-455-9965
  • Fax: 831-455-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: