Provider Demographics
NPI:1821641895
Name:OLIVERA ACEVEDO, EDUARDO MANUEL
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:MANUEL
Last Name:OLIVERA ACEVEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1396 CALLE BONITA CONDOMINIO BUENA VISTA
Mailing Address - Street 2:APT 203 C
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00717-2627
Mailing Address - Country:US
Mailing Address - Phone:787-504-1353
Mailing Address - Fax:
Practice Address - Street 1:1396 CALLE BONITA CONDOMINIO BUENA VISTA
Practice Address - Street 2:APT 203 C
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-2627
Practice Address - Country:US
Practice Address - Phone:787-504-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program