Provider Demographics
NPI:1104825983
Name:ACEVEDO LAZZARINI, LUIS G (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:G
Last Name:ACEVEDO LAZZARINI
Suffix:
Gender:M
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:PO BOX 1868
Mailing Address - Street 2:VICTORIA STATION
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-1868
Mailing Address - Country:US
Mailing Address - Phone:787-819-1215
Mailing Address - Fax:787-819-4902
Practice Address - Street 1:HOSPITAL BUEN SAMARITANO
Practice Address - Street 2:AVE KENNEDY #18 KM 1411
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-819-0800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4597207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D48291Medicare UPIN
0025317Medicare ID - Type Unspecified