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General NPI Number Information
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NPI Number | 1194304014
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Entity Type | Individual
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Provider Name | EDGAR ALLAN POU ACEVEDO MD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2021
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Last Update Date | 07/03/2025
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Provider Practice Location Address
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Address Line | CARR #2 KM 119.8 BO. CAIMITAL ALTO
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City | AGUADILLA
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State | PR
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Zip | 00603
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Country | US
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Telephone | 787-420-0834
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 779
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City | MOCA
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State | PR
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Zip | 00676-0779
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Country | US
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Telephone | 787-408-2533
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Fax |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 023556
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License Number State | PR
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