Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 21568 | PR |
NPI | 1013460617 |
---|---|
Provider Name | Dr. Jorge Acevedo Canabal |
First Address | San Juan, PR 00927-5209 |
Second Address | Aguadilla, PR 00603-1327 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2016 |
Last Update Date | 17/09/2019 |