Provider Demographics
NPI:1518510858
Name:ACEVEDO, CECIA DIANELY
Entity Type:Individual
Prefix:
First Name:CECIA
Middle Name:DIANELY
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 S 11TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-3212
Mailing Address - Country:US
Mailing Address - Phone:509-902-8585
Mailing Address - Fax:509-902-8030
Practice Address - Street 1:314 S 11TH AVE STE A
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3212
Practice Address - Country:US
Practice Address - Phone:509-902-8585
Practice Address - Fax:509-902-8030
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60959984133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered