Healthcare Provider Details

I. General information

NPI: 1992953814
Provider Name (Legal Business Name): NICOLAS LOPEZ ACEVEDO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 03/18/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 AVE FD ROOSEVELT STE 202
SAN JUAN PR
00918-2129
US

IV. Provider business mailing address

400 FD ROOSEVELT AVE. CLINICA LAS AMERICAS SUITE 202
SAN JUAN PR
00918
US

V. Phone/Fax

Practice location:
  • Phone: 787-724-9595
  • Fax:
Mailing address:
  • Phone: 787-724-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number17900
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number17900
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: