Healthcare Provider Details

I. General information

NPI: 1104825983
Provider Name (Legal Business Name): LUIS G ACEVEDO LAZZARINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HOSPITAL BUEN SAMARITANO AVE KENNEDY #18 KM 1411
AGUADILLA PR
00605
US

IV. Provider business mailing address

PO BOX 1868 VICTORIA STATION
AGUADILLA PR
00605-1868
US

V. Phone/Fax

Practice location:
  • Phone: 787-819-0800
  • Fax:
Mailing address:
  • Phone: 787-819-1215
  • Fax: 787-819-4902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4597
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: