Provider Demographics
NPI:1285873612
Name:ACEVEDO, JOHANNA (MD)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 3 BOX 16192
Mailing Address - Street 2:
Mailing Address - City:QUEBRADILLAS
Mailing Address - State:PR
Mailing Address - Zip Code:00678-9815
Mailing Address - Country:US
Mailing Address - Phone:787-895-4995
Mailing Address - Fax:787-262-2279
Practice Address - Street 1:HC 3 BOX 16192
Practice Address - Street 2:
Practice Address - City:QUEBRADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00678-9815
Practice Address - Country:US
Practice Address - Phone:787-895-4995
Practice Address - Fax:787-262-2279
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17328208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice