Provider Demographics
NPI:1245378736
Name:ACEVEDO, NORMA IRIS (PH D)
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:IRIS
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330B CIRCLE E
Mailing Address - Street 2:RAMEY BASE
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-1313
Mailing Address - Country:US
Mailing Address - Phone:787-717-0994
Mailing Address - Fax:787-890-3737
Practice Address - Street 1:330B CIRCLE E
Practice Address - Street 2:RAMEY BASE
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-1313
Practice Address - Country:US
Practice Address - Phone:787-717-0994
Practice Address - Fax:787-890-3737
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR201Medicare UPIN
PR59258Medicare UPIN
PR075064Medicare UPIN
PR00604-0000Medicare UPIN
PR8-4325Medicare ID - Type UnspecifiedMEDIACRE