Provider Demographics
NPI:1598113862
Name:ACEVEDO MARTINEZ, ZAIDA IVETTE (LND)
Entity Type:Individual
Prefix:MS
First Name:ZAIDA
Middle Name:IVETTE
Last Name:ACEVEDO MARTINEZ
Suffix:
Gender:F
Credentials:LND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1016
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-1016
Mailing Address - Country:US
Mailing Address - Phone:787-245-3627
Mailing Address - Fax:
Practice Address - Street 1:53 CALLE BETANCES
Practice Address - Street 2:
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-2859
Practice Address - Country:US
Practice Address - Phone:787-245-3627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1846133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist