Provider Demographics
NPI:1891836151
Name:ACEVEDO ORENGO, JORGE (MD)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:ACEVEDO ORENGO
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:PO BOX 1604
Mailing Address - Street 2:
Mailing Address - City:AIBONITO
Mailing Address - State:PR
Mailing Address - Zip Code:00705-1604
Mailing Address - Country:US
Mailing Address - Phone:787-735-3004
Mailing Address - Fax:787-735-7613
Practice Address - Street 1:STANLEY MILLER ST., MENNONITE GENERAL HOSP.
Practice Address - Street 2:BORINQUEN ANESTHESIA SERVICES, SUITE 107
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705
Practice Address - Country:US
Practice Address - Phone:787-735-3004
Practice Address - Fax:787-735-7613
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14192207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021196Medicare ID - Type Unspecified
H72793Medicare UPIN