Provider Demographics
NPI:1396958112
Name:ACEVEDO RODRIGUEZ, JAVIER (1292P)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:
Last Name:ACEVEDO RODRIGUEZ
Suffix:
Gender:M
Credentials:1292P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1740
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-1740
Mailing Address - Country:US
Mailing Address - Phone:939-272-7164
Mailing Address - Fax:787-898-7094
Practice Address - Street 1:CARR 111 KM 12
Practice Address - Street 2:BO CAGUANA
Practice Address - City:UTUADO
Practice Address - State:PR
Practice Address - Zip Code:00641-1740
Practice Address - Country:US
Practice Address - Phone:939-272-7164
Practice Address - Fax:787-898-7094
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1292P146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic