Healthcare Provider Details

I. General information

NPI: 1417865106
Provider Name (Legal Business Name): KIRIALYS MAYLEE ACEVEDO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MANSION DEL SOL VIA PRIMAVERAL MS 101
SABANA SECA PR
00952
US

IV. Provider business mailing address

MANSION DEL SOL VIA PRIMAVERAL MS 101
SABANA SECA PR
00952
US

V. Phone/Fax

Practice location:
  • Phone: 787-718-3931
  • Fax:
Mailing address:
  • Phone: 787-718-3931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number6776495
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: