Provider Demographics
NPI:1487799425
Name:ACEVEDO, LISETTE (TECH)
Entity type:Individual
Prefix:MRS
First Name:LISETTE
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114-25 CALLE 76
Mailing Address - Street 2:URB. VILLA CAROLINA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00985-4113
Mailing Address - Country:US
Mailing Address - Phone:787-207-2853
Mailing Address - Fax:787-765-5937
Practice Address - Street 1:455 PONCE DE LEON
Practice Address - Street 2:ESQ. RUIZ BELVIS, FLORAL PARK
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-207-2853
Practice Address - Fax:787-765-5937
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5365183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician