Provider Demographics
NPI:1245270560
Name:ACEVEDO, LORIEVA (MD)
Entity type:Individual
Prefix:MISS
First Name:LORIEVA
Middle Name:
Last Name: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 1:2009 CALLE CAUDAL
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00716-3604
Mailing Address - Country:US
Mailing Address - Phone:787-517-2656
Mailing Address - Fax:787-812-6666
Practice Address - Street 1:2956 AVE EMILIO FAGOT
Practice Address - Street 2:
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-3615
Practice Address - Country:US
Practice Address - Phone:787-812-6666
Practice Address - Fax:787-812-1666
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16226208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR23974ACOtherSSS
PRI51757Medicare UPIN
PR23974ACOtherSSS