Healthcare Provider Details

I. General information

NPI: 1578791646
Provider Name (Legal Business Name): BETSY GISSELLE COLON-ACEVEDO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 AVE HOSTOS STE 1
MAYAGUEZ PR
00682-6326
US

IV. Provider business mailing address

2625 AVE HOSTOS STE 1
MAYAGUEZ PR
00682-6326
US

V. Phone/Fax

Practice location:
  • Phone: 787-476-0333
  • Fax: 787-476-0332
Mailing address:
  • Phone: 787-645-0897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number18537
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number18537
License Number StatePR
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number18537
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: