Provider Demographics
NPI:1699383679
Name:MORO ACEVEDO, GRISELY (MD)
Entity Type:Individual
Prefix:DR
First Name:GRISELY
Middle Name:
Last Name:MORO ACEVEDO
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 1:110 RD KM 28.5 BO. AGUACATE
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9442
Mailing Address - Country:US
Mailing Address - Phone:787-223-0153
Mailing Address - Fax:
Practice Address - Street 1:110 RD KM 28.5 BO. AGUACATE
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-9442
Practice Address - Country:US
Practice Address - Phone:787-223-0153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-16
Last Update Date:2024-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21842208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice