Healthcare Provider Details

I. General information

NPI: 1861677247
Provider Name (Legal Business Name): ANGELA ACEVEDO MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6202 W CORPORATE OAKS DR
CRYSTAL RIVER FL
34429-2705
US

IV. Provider business mailing address

6202 W CORPORATE OAKS DR
CRYSTAL RIVER FL
34429-2705
US

V. Phone/Fax

Practice location:
  • Phone: 352-795-9697
  • Fax: 352-795-9698
Mailing address:
  • Phone: 352-795-9697
  • Fax: 352-795-9698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE ACEVEDO
Title or Position: OFFICE MANAGER
Credential:
Phone: 352-795-9697