MEDICARE: DR. MARJERY NANETTE LOPEZ-ACEVEDO 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	207R00000X	Internal Medicine Physician	14794	PR

General Provider Information

NPI Number	:	1316966252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARJERY NANETTE LOPEZ-ACEVEDO MD

Provider Business Mailing Address
First Line	:	1038 W NORTH BLVD
Second Line	:	SUITE 102
City	:	LEESBURG
State	:	FL
Zip	:	34748-5077
Country	:	US
Telephone Number	:	352-315-1627
Fax Number	:	352-326-8744

Provider Business Practice Location Address
First Line	:	AVE. SEVERIANO CUEVAS #18
Second Line	:
City	:	AGUADILLA
State	:	PR
Zip	:	00605-4055
Country	:	US
Telephone Number	:	787-997-1655
Fax Number	:	787-997-1655

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	12/17/2014

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