Provider Demographics
NPI:1104583582
Name:ACERO, JESUS MAURICIO (PA)
Entity type:Individual
Prefix:DR
First Name:JESUS
Middle Name:MAURICIO
Last Name:ACERO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 PARK WIND DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-4643
Mailing Address - Country:US
Mailing Address - Phone:409-419-8908
Mailing Address - Fax:
Practice Address - Street 1:23390 W YUMA RD STE 101B
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-3116
Practice Address - Country:US
Practice Address - Phone:623-594-4126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-20
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1141363A00000X
AZ9645363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant