1760432223 NPI number — DR. JUAN F CANCIO ACEVEDO MD

Table of content: DR. JUAN F CANCIO ACEVEDO MD (NPI 1760432223)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760432223 NPI number — DR. JUAN F CANCIO ACEVEDO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CANCIO ACEVEDO
Provider First Name:
JUAN
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1760432223
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34187
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT BUCHANAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00934-0187
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-263-0644
Provider Business Mailing Address Fax Number:
787-535-1024

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
706 CALLE ROOSEVELT
Provider Second Line Business Practice Location Address:
SUITE 1001 NORTE
Provider Business Practice Location Address City Name:
SAN JUAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00907-3402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-263-0644
Provider Business Practice Location Address Fax Number:
787-535-1024
Provider Enumeration Date:
05/12/2006

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: 2085R0202X , with the licence number:  12984 , 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: 7360037 , issued by the state of ( PR ) . This identifiers is of the category "MEDICAID".




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