Provider Demographics
NPI:1679677041
Name:ACEVEDO-MARTY, IRIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:A
Last Name:ACEVEDO-MARTY
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:PO BOX 4042
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4042
Mailing Address - Country:US
Mailing Address - Phone:787-882-1779
Mailing Address - Fax:787-882-1779
Practice Address - Street 1:106 AVE SEVERIANO CUEVAS
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-5769
Practice Address - Country:US
Practice Address - Phone:787-882-1779
Practice Address - Fax:787-891-2764
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR129892084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0090164Medicare ID - Type Unspecified
PRH95806Medicare UPIN