1326139239 NPI number — VIVIAN IVETTE ACEVEDO MD

Table of content: (NPI 1467039693)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326139239 NPI number — VIVIAN IVETTE ACEVEDO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACEVEDO
Provider First Name:
VIVIAN
Provider Middle Name:
IVETTE
Provider Name Prefix Text:
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:
1326139239
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CALLE MARIANO ABRIL FP-50
Provider Second Line Business Mailing Address:
SEXTA SECCION LEVITTOWN
Provider Business Mailing Address City Name:
TOA BAJA
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00949
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-798-2431
Provider Business Mailing Address Fax Number:
787-778-7505

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE BOULEVARD #2509
Provider Second Line Business Practice Location Address:
LEVITTOWN
Provider Business Practice Location Address City Name:
TOA BAJA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-798-2431
Provider Business Practice Location Address Fax Number:
939-204-9938
Provider Enumeration Date:
09/27/2006

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: 2084P0800X , with the licence number:  13472 , 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)

  • Identifier: 20190AC . This is a "TRIPLES" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 222118 . This is a "PREFERRED HEALTH" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: A905 . This is a "FIRST MEDICAL" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 1849 . This is a "MMM" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: 2149 . This is a "HUMANA" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".
  • Identifier: PU1073 . This is a "APS" identifier , issued by the state of ( PR ) . This identifiers is of the category "OTHER".




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