Provider Demographics
NPI:1841226644
Name:ACEVEDO-URCUYO, ALICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:
Last Name:ACEVEDO-URCUYO
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 1:9305 W. THOMAS ROAD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037
Mailing Address - Country:US
Mailing Address - Phone:602-288-9719
Mailing Address - Fax:602-288-9719
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:SUITE 290
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3328
Practice Address - Country:US
Practice Address - Phone:602-288-9719
Practice Address - Fax:602-288-9719
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ32996207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ870859Medicaid
I11824Medicare UPIN
AZ870859Medicaid