Provider Demographics
NPI:1184602716
Name:ACEVEDO VAZQUEZ, MOISES ORLANDO (MD)
Entity type:Individual
Prefix:DR
First Name:MOISES
Middle Name:ORLANDO
Last Name:ACEVEDO VAZQUEZ
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:# 17 N PERAL STREET
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680
Mailing Address - Country:US
Mailing Address - Phone:787-833-3168
Mailing Address - Fax:787-265-3191
Practice Address - Street 1:17 CALLE PERAL N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4822
Practice Address - Country:US
Practice Address - Phone:787-833-3168
Practice Address - Fax:787-265-3191
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR53772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5377OtherCIGNA
3003086OtherACAA
660440357OtherCOSVI
810066OtherMMM
1555 4OtherAMPR
1555 5OtherAMPR
2824 4OtherAMPR
660440357OtherMAPFRI
066978OtherCRUZ AZUL
20350OtherAMERICAN HEALTH INC
2824 5OtherAMERICAN HEALTH INC
660440357OtherMAPFRI
PR26877Medicare ID - Type Unspecified