Provider Demographics
NPI:1730176595
Name:ACEVEDO-VARGAS, LUZ M (MD)
Entity type:Individual
Prefix:DR
First Name:LUZ
Middle Name:M
Last Name:ACEVEDO-VARGAS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:265A CALLE 20
Mailing Address - Street 2:URB PONCE DE LEON
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4447
Mailing Address - Country:US
Mailing Address - Phone:787-757-6545
Mailing Address - Fax:787-757-7820
Practice Address - Street 1:D22 CALLE YUNQUESITO
Practice Address - Street 2:URB LOMAS DE CAROLINA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-8008
Practice Address - Country:US
Practice Address - Phone:787-757-6545
Practice Address - Fax:787-757-7820
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2010-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR8710207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRD34256Medicare UPIN
PR80033Medicare ID - Type UnspecifiedMEDICARE NUMBER