Provider Demographics
NPI:1821358375
Name:ACEVES, THADEO J (PA-C)
Entity Type:Individual
Prefix:
First Name:THADEO
Middle Name:J
Last Name:ACEVES
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:1700 MCHENRY AVE
Mailing Address - Street 2:STE 65B #259
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350
Mailing Address - Country:US
Mailing Address - Phone:209-576-3525
Mailing Address - Fax:209-383-1296
Practice Address - Street 1:1441 FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4404
Practice Address - Country:US
Practice Address - Phone:209-576-3525
Practice Address - Fax:209-576-3544
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2021-01-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA22255363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant