Healthcare Provider Details

I. General information

NPI: 1487535407
Provider Name (Legal Business Name): KEVIN J ALVARADO ACEVEDO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8169 CALLE CONCORDIA
PONCE PR
00717-1554
US

IV. Provider business mailing address

PO BOX 517
ADJUNTAS PR
00601-0517
US

V. Phone/Fax

Practice location:
  • Phone: 787-284-5884
  • Fax:
Mailing address:
  • Phone: 787-380-4452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: