Healthcare Provider Details

I. General information

NPI: 1437675311
Provider Name (Legal Business Name): VALERIA M ACEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 08/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CARR 2 KM 157.0 ASSMCA
MAYAGUEZ PR
00680
US

IV. Provider business mailing address

PO BOX 424
HORMIGUEROS PR
00660-0424
US

V. Phone/Fax

Practice location:
  • Phone: 787-833-0663
  • Fax:
Mailing address:
  • Phone: 787-528-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2733
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: