Provider Demographics
NPI:1972707248
Name:VELEZ ACEVEDO, IVONNE (MD)
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:
Last Name:VELEZ ACEVEDO
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:CORRIENTES CO-40 CALLE RIO GRANDE
Mailing Address - Street 2:
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6194
Mailing Address - Country:US
Mailing Address - Phone:787-200-6884
Mailing Address - Fax:
Practice Address - Street 1:116-2 CALLE 74
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985-4117
Practice Address - Country:US
Practice Address - Phone:787-762-6532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN52396207P00000X
PR18451207P00000X
PR11443390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNENROLLEDMedicaid
MNP00898121OtherMEDICARE, RAILROAD
MNENROLLEDMedicaid