Provider Demographics
NPI:1588807929
Name:ACEVES, STEPHEN (ORTHOTIST)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:ACEVES
Suffix:
Gender:M
Credentials:ORTHOTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2655 HIDDEN RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-4013
Mailing Address - Country:US
Mailing Address - Phone:817-469-1951
Mailing Address - Fax:817-860-4472
Practice Address - Street 1:2655 HIDDEN RIDGE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-4013
Practice Address - Country:US
Practice Address - Phone:817-469-1951
Practice Address - Fax:817-860-4472
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC17320332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment