Healthcare Provider Details

I. General information

NPI: 1942315346
Provider Name (Legal Business Name): ELBA I ACEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CONCEPCION VERA STREET
MOCA PR
00676
US

IV. Provider business mailing address

PO BOX 1615
MOCA PR
00676-1615
US

V. Phone/Fax

Practice location:
  • Phone: 787-877-0110
  • Fax: 787-877-0110
Mailing address:
  • Phone: 787-207-6523
  • Fax: 787-877-5803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number2679
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: