Healthcare Provider Details

I. General information

NPI: 1902159049
Provider Name (Legal Business Name): ACEVEDO MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 09/04/2024
Certification Date: 09/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

URB CONSTANCIA 2664 LAS AMERICAS
PONCE PR
00717
US

IV. Provider business mailing address

URB VALLE VERDE 2009 CALLE CAUDAL
PONCE PR
00716
US

V. Phone/Fax

Practice location:
  • Phone: 787-812-6666
  • Fax: 787-812-6666
Mailing address:
  • Phone: 787-812-6666
  • Fax: 787-812-6666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number16226
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LORIEVA ACEVEDO NEGRON
Title or Position: PRESIDENTA
Credential: M.D.
Phone: 787-812-6666