1427318195 NPI number — MEDICINE INTERNAL DRA SARA ACEVEDO CSP

Table of content: DR. GERALD D CHITTERS M D (NPI 1366452310)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427318195 NPI number — MEDICINE INTERNAL DRA SARA ACEVEDO CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICINE INTERNAL DRA SARA ACEVEDO CSP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1427318195
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 29499
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN JUAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00929-0499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-776-7012
Provider Business Mailing Address Fax Number:
787-776-7013

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
AVE SANCHEZ OSORIO # 5-G4
Provider Second Line Business Practice Location Address:
VILLA FONTANA
Provider Business Practice Location Address City Name:
CAROLINA
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00983-3226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-776-7012
Provider Business Practice Location Address Fax Number:
787-776-7013
Provider Enumeration Date:
05/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ACEVEDO
Authorized Official First Name:
SARA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
INTERNAL MEDICINE
Authorized Official Telephone Number:
787-776-7012

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0011448 , 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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