Provider Demographics
NPI:1902159049
Name:ACEVEDO MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:ACEVEDO MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENTA
Authorized Official - Prefix:
Authorized Official - First Name:LORIEVA
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO NEGRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-812-6666
Mailing Address - Street 1:URB VALLE VERDE
Mailing Address - Street 2:2009 CALLE CAUDAL
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716
Mailing Address - Country:US
Mailing Address - Phone:787-812-6666
Mailing Address - Fax:787-812-6666
Practice Address - Street 1:URB CONSTANCIA
Practice Address - Street 2:2664 LAS AMERICAS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717
Practice Address - Country:US
Practice Address - Phone:787-812-6666
Practice Address - Fax:787-812-6666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16226208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI51757Medicare UPIN
PR0023974Medicare PIN