Provider Demographics
NPI:1699743864
Name:ACEVEDO, MARIBEL (MD)
Entity type:Individual
Prefix:
First Name:MARIBEL
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ARBOLOTE AVE.
Mailing Address - Street 2:PALMAR DEL RIO COND. #336
Mailing Address - City:GUAYNABO
Mailing Address - State:PUERTO RICO
Mailing Address - Zip Code:00969
Mailing Address - Country:UM
Mailing Address - Phone:787-528-1828
Mailing Address - Fax:
Practice Address - Street 1:18 AVE ARBOLOTE
Practice Address - Street 2:PALMAR DEL RIO CONDOMINIUM APARTMENT A407
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5511
Practice Address - Country:US
Practice Address - Phone:787-528-1828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14317208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-05102Medicare UPIN
PR0022245Medicare ID - Type Unspecified