Provider Demographics
NPI:1629355177
Name:ACEVEDO, DOMINIC JOSEPH
Entity type:Individual
Prefix:MR
First Name:DOMINIC
Middle Name:JOSEPH
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 1:124 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93908-9601
Mailing Address - Country:US
Mailing Address - Phone:831-455-9965
Mailing Address - Fax:831-455-4777
Practice Address - Street 1:2275 ARLINGTON DR.
Practice Address - Street 2:SAN LEANDRO
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578
Practice Address - Country:US
Practice Address - Phone:510-481-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other