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General NPI Number Information
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NPI Number | 1750136461
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Entity Type | Individual
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Provider Name | FERNANDO PESANTE ACEVEDO CORP.
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Gender | Male
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Dates
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Enumeration Date | 04/17/2024
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Last Update Date | 06/30/2025
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Provider Practice Location Address
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Address Line | BO. CERRO LAS MESAS CARR. 349
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City | MAYAGUEZ
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State | PR
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Zip | 00680-0000
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Country | US
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Telephone | 939-376-2460
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Fax |
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Provider Business Mailing Address
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Address Line | RR 3 BOX 10464
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City | ANASCO
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State | PR
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Zip | 00610-9182
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Country | US
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Telephone | 939-376-2460
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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 | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number | 101891
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License Number State | PR
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