Provider Demographics
NPI:1679542690
Name:ACOSTA VELEZ, PABLO A (MD)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:A
Last Name:ACOSTA VELEZ
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:PO BOX 3067
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3067
Mailing Address - Country:US
Mailing Address - Phone:787-267-5923
Mailing Address - Fax:787-267-5923
Practice Address - Street 1:CALLE 25 DE JULIO #17
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:787-267-5923
Practice Address - Fax:787-267-5923
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10860207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F47626Medicare UPIN
PR82963Medicare PIN
PR84375BMedicare PIN