Provider Demographics
NPI:1467203026
Name:ACEVEDO, X-AVIER K
Entity Type:Individual
Prefix:
First Name:X-AVIER
Middle Name:K
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 E TREMONT AVE APT 2A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-5743
Mailing Address - Country:US
Mailing Address - Phone:646-894-6107
Mailing Address - Fax:
Practice Address - Street 1:1516 BERGEN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1658
Practice Address - Country:US
Practice Address - Phone:347-915-1112
Practice Address - Fax:347-915-1113
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program