Healthcare Provider Details

I. General information

NPI: 1104654912
Provider Name (Legal Business Name): DANIEL C. ACEVEDO, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

258 LOMBARD ST # 200
THOUSAND OAKS CA
91360-5806
US

IV. Provider business mailing address

23371 MULHOLLAND DR # 177
WOODLAND HILLS CA
91364-2734
US

V. Phone/Fax

Practice location:
  • Phone: 805-497-0817
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL ACEVEDO
Title or Position: CEO
Credential: MD
Phone: 818-632-0873