Provider Demographics
NPI:1447959309
Name:ACEVEDO, JORGE JOEL
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:JOEL
Last Name:ACEVEDO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LOS PRADOS, EL VALLE
Mailing Address - Street 2:PASEO FLAMBOYAN D-4
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-247-0569
Mailing Address - Fax:
Practice Address - Street 1:LOS PRADOS, EL VALLE
Practice Address - Street 2:PASEO FLAMBOYAN D-4
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-247-0569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program