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General NPI Number Information
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NPI Number | 1063451433
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Entity Type | Individual
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Provider Name | WALDO ACEBO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 9851 NW 58TH ST SUITE 125
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City | DORAL
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State | FL
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Zip | 33178-2716
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Country | US
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Telephone | 305-403-1035
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Fax | 305-403-1036
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Provider Business Mailing Address
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Address Line | 9851 NW 58TH ST SUITE 125
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City | DORAL
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State | FL
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Zip | 33178-2716
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Country | US
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Telephone | 305-403-1035
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Fax | 305-403-1036
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME81372
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License Number State | FL
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