MEDICARE: DR. LUZ M ACEVEDO-VARGAS 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	207QG0300X	Geriatric Medicine (Family Medicine) Physician	8710	PR

General Provider Information

NPI Number	:	1730176595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LUZ M ACEVEDO-VARGAS MD

Provider Business Mailing Address
First Line	:	265A CALLE 20
Second Line	:	URB PONCE DE LEON
City	:	GUAYNABO
State	:	PR
Zip	:	00969-4447
Country	:	US
Telephone Number	:	787-757-6545
Fax Number	:	787-757-7820

Provider Business Practice Location Address
First Line	:	D22 CALLE YUNQUESITO
Second Line	:	URB LOMAS DE CAROLINA
City	:	CAROLINA
State	:	PR
Zip	:	00987-8008
Country	:	US
Telephone Number	:	787-757-6545
Fax Number	:	787-757-7820

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

Provider Enumeration Date	:	10/05/2005
Last Update Date	:	09/14/2010

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