Provider Demographics
NPI:1144434929
Name:ACEVEDO MALAVE, HECTOR M
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:M
Last Name:ACEVEDO MALAVE
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:HC 1 BOX 4237
Mailing Address - Street 2:
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-9605
Mailing Address - Country:US
Mailing Address - Phone:787-207-0672
Mailing Address - Fax:787-897-0079
Practice Address - Street 1:BO CALLEJONES CARR 454
Practice Address - Street 2:
Practice Address - City:LARES
Practice Address - State:PR
Practice Address - Zip Code:00669-9615
Practice Address - Country:US
Practice Address - Phone:787-207-0672
Practice Address - Fax:787-897-0079
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1123P146L00000X
PRTC-AMB-3433416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic