Provider Demographics
NPI:1750117016
Name:ACERO, MICHAEL EARL IV
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EARL
Last Name:ACERO
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5330 DURALITE ST UNIT 203
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89122-7364
Mailing Address - Country:US
Mailing Address - Phone:714-292-6726
Mailing Address - Fax:
Practice Address - Street 1:5330 DURALITE ST UNIT 203
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89122-7364
Practice Address - Country:US
Practice Address - Phone:714-292-6726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCHW1-5829172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker