Provider Demographics
NPI:1689663817
Name:ACEVEDO, ANGEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:ACEVEDO
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 1:107 CALLE 1
Mailing Address - Street 2:PASEO LAS VISTAS
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-5101
Mailing Address - Country:US
Mailing Address - Phone:787-293-2886
Mailing Address - Fax:787-293-2886
Practice Address - Street 1:107 CALLE 1
Practice Address - Street 2:URB. PASEO LAS VISTAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-293-2886
Practice Address - Fax:787-293-2886
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10520208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRMCSOtherMEDICAL CARD SYSTEM
PR300132OtherMEDICARE Y MUCHO MAS
PR21715OtherSSS
PR9090182Other9090182
PR3310OtherPREFERRED MEDICAL CHOICE
PR9090182Other9090182
PR0021715Medicare ID - Type Unspecified