Healthcare Provider Details

I. General information

NPI: 1790904050
Provider Name (Legal Business Name): ANA ACEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 CARR K1.0 BO JAGUITA
HORMIGUEROS PR
00660
US

IV. Provider business mailing address

SEC.PUNTO CUBANO CARR.344 K.1 JAGUITAS
HORMIGUEROS PR
00660
US

V. Phone/Fax

Practice location:
  • Phone: 787-849-6773
  • Fax:
Mailing address:
  • Phone: 787-849-6773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number171M00000X
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: