Provider Demographics
NPI:1780985614
Name:ACEVEDO-ORTA, EDUARDO (RNBSN)
Entity type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:ACEVEDO-ORTA
Suffix:
Gender:M
Credentials:RNBSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 STREET BO. ESPINO
Mailing Address - Street 2:HC-03 BOX 8725
Mailing Address - City:LARES
Mailing Address - State:PR
Mailing Address - Zip Code:00669-8725
Mailing Address - Country:US
Mailing Address - Phone:787-613-3791
Mailing Address - Fax:
Practice Address - Street 1:129 STREET ANTIGUO HOSPITAL DE DISTRITO-ASSMCA
Practice Address - Street 2:COTTO STATION BOX 9550
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00613
Practice Address - Country:US
Practice Address - Phone:787-878-3552
Practice Address - Fax:787-879-8633
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19085163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice