=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326930009
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YAMIL GONZALEZ ACEVEDO MS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2025
-----------------------------------------------------
Last Update Date | 07/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | URB, #51 CALLE MARGINAL
-----------------------------------------------------
City | JUNCOS
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00777
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-679-6569
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 258
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00690-0258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-297-1803
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TF0000X
-----------------------------------------------------
Taxonomy Name | Family Psychologist
-----------------------------------------------------
License Number | 007354
-----------------------------------------------------
License Number State | PR
-----------------------------------------------------