Provider Demographics
NPI:1669873717
Name:ACEVEDO, ROBERTO (NP)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 N CONWAY AVE
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78574-2347
Mailing Address - Country:US
Mailing Address - Phone:956-833-5437
Mailing Address - Fax:956-833-5444
Practice Address - Street 1:2412 N CONWAY AVE
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78574-2347
Practice Address - Country:US
Practice Address - Phone:956-833-5437
Practice Address - Fax:956-833-5444
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126314363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner