Healthcare Provider Details

I. General information

NPI: 1336164920
Provider Name (Legal Business Name): JAVIER ACEVES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

YOUNG CHILDREN'S HEALTH CENTER 306-A SAN PABLO SE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

306 SAN PABLO ST SE STE A MSC10 5590
ALBUQUERQUE NM
87108-3167
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-2345
  • Fax:
Mailing address:
  • Phone: 505-272-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number90-140
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: