Provider Demographics
NPI:1881719847
Name:ACEVEDO, VIVIAN JEANNETTE
Entity type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:JEANNETTE
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L3 CALLE 7
Mailing Address - Street 2:EL MIRADOR
Mailing Address - City:RIO PIEDRAS
Mailing Address - State:PR
Mailing Address - Zip Code:00926-7590
Mailing Address - Country:US
Mailing Address - Phone:787-707-2580
Mailing Address - Fax:
Practice Address - Street 1:L3 CALLE 7
Practice Address - Street 2:EL MIRADOR
Practice Address - City:RIO PIEDRAS
Practice Address - State:PR
Practice Address - Zip Code:00926-7590
Practice Address - Country:US
Practice Address - Phone:787-707-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist