MEDICARE: JOSE JUAN ACEVEDO-VALLES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	13856	PR

General Provider Information

NPI Number	:	1215933916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE JUAN ACEVEDO-VALLES MD

Provider Business Mailing Address
First Line	:	PO BOX 11577
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00910-2677
Country	:	US
Telephone Number	:	787-710-7109
Fax Number	:	787-723-5015

Provider Business Practice Location Address
First Line	:	1492 AVE PONCE DE LEON # 500
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00907-4012
Country	:	US
Telephone Number	:	787-723-5017
Fax Number	:	787-723-5015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	07/30/2019

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