Provider Demographics
NPI:1912058256
Name:ACEBO, CARMEN I (LSA)
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:I
Last Name:ACEBO
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 431124
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77243-1124
Mailing Address - Country:US
Mailing Address - Phone:281-829-0941
Mailing Address - Fax:281-829-9149
Practice Address - Street 1:20023 SKY HOLLOW LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-5219
Practice Address - Country:US
Practice Address - Phone:281-829-0941
Practice Address - Fax:281-829-9149
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA 0005363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical