Healthcare Provider Details

I. General information

NPI: 1457419152
Provider Name (Legal Business Name): CARLOS M ACEVEDO-SOTO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1534 CALLE 10 SW CAPARRA TERRACE
SAN JUAN PR
00921-1527
US

IV. Provider business mailing address

836 CALLE ARTURO PASARELL VILLA PRADES
SAN JUAN PR
00924-2124
US

V. Phone/Fax

Practice location:
  • Phone: 787-226-5387
  • Fax:
Mailing address:
  • Phone: 787-390-4529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13616
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: