1316966252 NPI number — DR. MARJERY NANETTE LOPEZ-ACEVEDO MD

Table of content: DR. MARJERY NANETTE LOPEZ-ACEVEDO MD (NPI 1316966252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316966252 NPI number — DR. MARJERY NANETTE LOPEZ-ACEVEDO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPEZ-ACEVEDO
Provider First Name:
MARJERY
Provider Middle Name:
NANETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316966252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1038 W NORTH BLVD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34748-5077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-315-1627
Provider Business Mailing Address Fax Number:
352-326-8744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE. SEVERIANO CUEVAS #18
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AGUADILLA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00605-4055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-997-1655
Provider Business Practice Location Address Fax Number:
787-997-1655
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  14794 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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