Provider Demographics
NPI:1235358904
Name:ACEVEDO, SANDRA I (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:I
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:URB. PASEO LOS CORALES
Mailing Address - Street 2:666 CALLE CABO DE HORNOS
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646
Mailing Address - Country:US
Mailing Address - Phone:787-385-5860
Mailing Address - Fax:
Practice Address - Street 1:CENTRO DE SERVICIOS MEDICOS INTEGRADOS
Practice Address - Street 2:CALLE SANTA CRUZ #59 4TO PISO
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961
Practice Address - Country:US
Practice Address - Phone:787-385-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13530208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRBA6803414OtherDEA NUMBER