Provider Demographics
NPI:1326139239
Name:ACEVEDO, VIVIAN IVETTE (MD)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:IVETTE
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:CALLE MARIANO ABRIL FP-50
Mailing Address - Street 2:SEXTA SECCION LEVITTOWN
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-798-2431
Mailing Address - Fax:787-778-7505
Practice Address - Street 1:AVE BOULEVARD #2509
Practice Address - Street 2:LEVITTOWN
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-798-2431
Practice Address - Fax:939-204-9938
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR134722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR20190ACOtherTRIPLES
PR222118OtherPREFERRED HEALTH
PRA905OtherFIRST MEDICAL
PR1849OtherMMM
PR2149OtherHUMANA
PRPU1073OtherAPS
PR0020190Medicare ID - Type Unspecified
PRA905OtherFIRST MEDICAL