Provider Demographics
NPI:1932171063
Name:ACEVEDO HERNANDEZ, ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:
Last Name:ACEVEDO HERNANDEZ
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:PO BOX 2039
Mailing Address - Street 2:
Mailing Address - City:HATILLO
Mailing Address - State:PR
Mailing Address - Zip Code:00659-2039
Mailing Address - Country:US
Mailing Address - Phone:787-650-3181
Mailing Address - Fax:888-972-1752
Practice Address - Street 1:CARRETERA 130 KM 0.9 BO PUEBLO
Practice Address - Street 2:
Practice Address - City:HATILOO
Practice Address - State:PR
Practice Address - Zip Code:00659
Practice Address - Country:US
Practice Address - Phone:787-650-3181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11973208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRG41808Medicare UPIN
PR0088443Medicare ID - Type Unspecified