Provider Demographics
NPI:1578614202
Name:ACEVEDO VILA, CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:
Last Name:ACEVEDO VILA
Suffix:
Gender:M
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:URB. EL VALLE
Mailing Address - Street 2:PASEO DE LA PALMA REAL #101
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727-3205
Mailing Address - Country:US
Mailing Address - Phone:787-737-5033
Mailing Address - Fax:787-737-0244
Practice Address - Street 1:CARRETERA 941
Practice Address - Street 2:SALIDA BARRIO JAGUAS
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-5033
Practice Address - Fax:787-737-0244
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15126208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22157Medicare ID - Type Unspecified