MEDICARE: DR. CARLOS M ACEVEDO-SOTO M.D.

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	208D00000X	General Practice Physician	13616	PR

General Provider Information

NPI Number	:	1457419152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARLOS M ACEVEDO-SOTO M.D.

Provider Business Mailing Address
First Line	:	836 CALLE ARTURO PASARELL
Second Line	:	VILLA PRADES
City	:	SAN JUAN
State	:	PR
Zip	:	00924-2124
Country	:	US
Telephone Number	:	787-390-4529
Fax Number	:

Provider Business Practice Location Address
First Line	:	1534 CALLE 10 SW
Second Line	:	CAPARRA TERRACE
City	:	SAN JUAN
State	:	PR
Zip	:	00921-1527
Country	:	US
Telephone Number	:	787-226-5387
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	03/07/2023

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