Healthcare Provider Details

I. General information

NPI: 1164671285
Provider Name (Legal Business Name): ILIANETTE RUIZ-ACEVEDO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2008
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CALLE COLON
AGUADA PR
00602-3105
US

IV. Provider business mailing address

90 CALLE COLON
AGUADA PR
00602-3105
US

V. Phone/Fax

Practice location:
  • Phone: 787-546-0461
  • Fax: 787-252-0436
Mailing address:
  • Phone: 787-546-0461
  • Fax: 787-252-0436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number20389
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20389
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: