Provider Demographics
NPI:1316966252
Name:LOPEZ-ACEVEDO, MARJERY NANETTE (MD)
Entity type:Individual
Prefix:DR
First Name:MARJERY
Middle Name:NANETTE
Last Name:LOPEZ-ACEVEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1038 W NORTH BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-5077
Mailing Address - Country:US
Mailing Address - Phone:352-315-1627
Mailing Address - Fax:352-326-8744
Practice Address - Street 1:AVE. SEVERIANO CUEVAS #18
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605-4055
Practice Address - Country:US
Practice Address - Phone:787-997-1655
Practice Address - Fax:787-997-1655
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR14794207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine