Provider Demographics
NPI:1154962314
Name:ACEVES, EMMANUEL FRANCISCO
Entity type:Individual
Prefix:
First Name:EMMANUEL
Middle Name:FRANCISCO
Last Name:ACEVES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38118 MIRAMONTE AVE
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4443
Mailing Address - Country:US
Mailing Address - Phone:818-270-3709
Mailing Address - Fax:
Practice Address - Street 1:38118 MIRAMONTE AVE
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4443
Practice Address - Country:US
Practice Address - Phone:818-270-3709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator