Healthcare Provider Details

I. General information

NPI: 1891607412
Provider Name (Legal Business Name): MIGUEL ANGEL CORREA ACEVEDO MD,PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARRETERA 111 KM 1.9
LARES PR
00669
US

IV. Provider business mailing address

CALLE 10 CASA 219 ISLOTE 2
ARECIBO PR
00612
US

V. Phone/Fax

Practice location:
  • Phone: 787-897-2727
  • Fax:
Mailing address:
  • Phone: 787-317-9308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3094
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: