Provider Demographics
NPI:1669243226
Name:ACEVEDO, MAYRA ALEJANDRA (BACHELOR)
Entity type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:ALEJANDRA
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:BACHELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38A CARR 696
Mailing Address - Street 2:
Mailing Address - City:DORADO
Mailing Address - State:PR
Mailing Address - Zip Code:00646-5843
Mailing Address - Country:US
Mailing Address - Phone:787-224-3808
Mailing Address - Fax:
Practice Address - Street 1:38A CARR 696
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-5843
Practice Address - Country:US
Practice Address - Phone:787-224-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR71792355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty