Provider Demographics
NPI:1992846521
Name:ACEVEDO AND HERRERA MD, INC
Entity Type:Organization
Organization Name:ACEVEDO AND HERRERA MD, INC
Other - Org Name:ACEVEDO & HERRERA MD PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-649-8870
Mailing Address - Street 1:351 NW 42ND AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5683
Mailing Address - Country:US
Mailing Address - Phone:306-649-8870
Mailing Address - Fax:305-649-3262
Practice Address - Street 1:351 NW 42ND AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5683
Practice Address - Country:US
Practice Address - Phone:306-649-8870
Practice Address - Fax:305-649-3262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACEVEDO AND HERRERA MD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-08
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373172300Medicaid
FL90508OtherBLUE CROSS BLUE SHIELD