Provider Demographics
NPI:1457419152
Name:ACEVEDO-SOTO, CARLOS M (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:M
Last Name:ACEVEDO-SOTO
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 1:836 CALLE ARTURO PASARELL
Mailing Address - Street 2:VILLA PRADES
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-2124
Mailing Address - Country:US
Mailing Address - Phone:787-390-4529
Mailing Address - Fax:
Practice Address - Street 1:1534 CALLE 10 SW
Practice Address - Street 2:CAPARRA TERRACE
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-1527
Practice Address - Country:US
Practice Address - Phone:787-226-5387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13616208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRBA6949905OtherDEA
PRH55660Medicare UPIN
PRBA6949905OtherDEA