Healthcare Provider Details

I. General information

NPI: 1114044930
Provider Name (Legal Business Name): ACEITUNO & ACEITUNO LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2007
Last Update Date: 03/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3231 SUPERIOR LN A-28
BOWIE MD
20715-1923
US

IV. Provider business mailing address

3231 SUPERIOR LN A-28
BOWIE MD
20715-1923
US

V. Phone/Fax

Practice location:
  • Phone: 301-262-1180
  • Fax:
Mailing address:
  • Phone: 301-262-1180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIA A ACEITUNO
Title or Position: ADMINISTRATOR
Credential: MANBCC
Phone: 301-262-1180