Healthcare Provider Details

I. General information

NPI: 1821080136
Provider Name (Legal Business Name): JESSICA I ACEVEDO-GRACIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5817 PATTON ST SUITE 101
CORPUS CHRISTI TX
78414
US

IV. Provider business mailing address

5817 PATTON ST STE 101
CORPUS CHRISTI TX
78414-2428
US

V. Phone/Fax

Practice location:
  • Phone: 361-992-9383
  • Fax: 361-992-9543
Mailing address:
  • Phone: 361-992-9383
  • Fax: 361-992-9543

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberL9052
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: