Provider Demographics
NPI:1851084412
Name:ACEVEDO SOTO, LUIS ALFREDO (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:ALFREDO
Last Name:ACEVEDO SOTO
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:HC 3 BOX 36129
Mailing Address - Street 2:
Mailing Address - City:SAN SEBASTIAN
Mailing Address - State:PR
Mailing Address - Zip Code:00685-7569
Mailing Address - Country:US
Mailing Address - Phone:787-307-7539
Mailing Address - Fax:
Practice Address - Street 1:AVE. HOSTOS 410 CAR 2 BO SABALOS
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-307-7539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16567-I207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine