Provider Demographics
NPI:1013246586
Name:ACEVEDO, CHRISTIAN JOEL
Entity type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:JOEL
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:636 CALLE 20
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-4806
Mailing Address - Country:US
Mailing Address - Phone:787-453-7869
Mailing Address - Fax:
Practice Address - Street 1:636 CALLE 20
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-4806
Practice Address - Country:US
Practice Address - Phone:787-453-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-13
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6263183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician