Healthcare Provider Details

I. General information

NPI: 1669159463
Provider Name (Legal Business Name): EVELIDIZ MARIE ACEVEDO TOLEDO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URBANIZACION ATENAS
MANATI PR
00674
US

IV. Provider business mailing address

HC 2 BOX 6442
LARES PR
00669-9760
US

V. Phone/Fax

Practice location:
  • Phone: 787-621-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25177
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: