Provider Demographics
NPI:1558314856
Name:RABELO ACEVEDO, MARIELSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIELSA
Middle Name:
Last Name:RABELO 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:CALLE SEGOVIA 514
Mailing Address - Street 2:URB VISTAMAR
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00983
Mailing Address - Country:US
Mailing Address - Phone:787-486-1413
Mailing Address - Fax:
Practice Address - Street 1:ASHFORD MEDICAL CTR
Practice Address - Street 2:SUITE 403
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1510
Practice Address - Country:US
Practice Address - Phone:787-722-6350
Practice Address - Fax:787-289-0096
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14869207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0024494Medicare PIN