Provider Demographics
NPI:1740754340
Name:ACEVEDO PENA, MANUEL ALEJANDRO (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:ALEJANDRO
Last Name:ACEVEDO PENA
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:EL VALLE 101 CALLE PASEO DE LA PALMA REAL
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:939-276-6967
Mailing Address - Fax:939-276-6967
Practice Address - Street 1:18 KM 141.1 BO. CAIMITAL BAJO
Practice Address - Street 2:HOSP. BUEN SAMARITANO AVE. SEVERIANO CUEVAS
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-658-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14980I208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice