Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 0612 | PR |
NPI | 1093263303 |
---|---|
Provider Name | Dr. Jean Carlos Acevedo |
First Address | Arecibo, PR 00614-0382 |
Second Address | Hatillo, PR 00659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2016 |
Last Update Date | 15/09/2016 |