Healthcare Provider Details

I. General information

NPI: 1215933916
Provider Name (Legal Business Name): JOSE JUAN ACEVEDO-VALLES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 07/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1492 AVE PONCE DE LEON # 500
SAN JUAN PR
00907-4012
US

IV. Provider business mailing address

PO BOX 11577
SAN JUAN PR
00910-2677
US

V. Phone/Fax

Practice location:
  • Phone: 787-723-5017
  • Fax: 787-723-5015
Mailing address:
  • Phone: 787-710-7109
  • Fax: 787-723-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number13856
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: