Healthcare Provider Details

I. General information

NPI: 1730176595
Provider Name (Legal Business Name): LUZ M ACEVEDO-VARGAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

D22 CALLE YUNQUESITO URB LOMAS DE CAROLINA
CAROLINA PR
00987-8008
US

IV. Provider business mailing address

265A CALLE 20 URB PONCE DE LEON
GUAYNABO PR
00969-4447
US

V. Phone/Fax

Practice location:
  • Phone: 787-757-6545
  • Fax: 787-757-7820
Mailing address:
  • Phone: 787-757-6545
  • Fax: 787-757-7820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number8710
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: