Provider Demographics
NPI:1780335216
Name:BERRIOS ACEVEDO, LADY MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:LADY
Middle Name:MARIE
Last Name:BERRIOS ACEVEDO
Suffix:
Gender:F
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:BO QUEBRADILLAS CARR. 152 KM 8.0
Mailing Address - Street 2:
Mailing Address - City:BARRANQUITAS
Mailing Address - State:PR
Mailing Address - Zip Code:00794
Mailing Address - Country:US
Mailing Address - Phone:787-857-0300
Mailing Address - Fax:
Practice Address - Street 1:CARR 152 KM 8.0
Practice Address - Street 2:
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794
Practice Address - Country:US
Practice Address - Phone:787-857-0510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-17
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR23269208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice