Provider Demographics
NPI:1689388803
Name:ACEVEDO MUJICA, RAQUEL YASMIN
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:YASMIN
Last Name:ACEVEDO MUJICA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W FALL RD
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-1124
Mailing Address - Country:US
Mailing Address - Phone:929-280-1804
Mailing Address - Fax:
Practice Address - Street 1:1801 W FALL RD
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1124
Practice Address - Country:US
Practice Address - Phone:929-280-1804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY797713163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health