Mayda I Acevedo, M.S.,IBCLC

Individual provider Active NPI Registered Dietitian · Arecibo, PR

NPI 1093884546 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1093884546
Entity type
Individual (NPI type 1)
Primary specialty
Registered Dietitian 133V00000X
License
952 (PR)
Practice address
Carr 2 Ave. de Diego 435
Arecibo, PR 00612
Phone
(787) 817-4962
NPI assigned
Nov 7, 2006
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Enrolled in PR

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20070302000370 PR Practitioner - Registered Dietitian Or Nutrition Professional 2365544798 Practice locations: Arecibo, PR

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
952PRMDRegistered Dietitian

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X 952 PR Yes

Addresses

Primary practice location

Carr 2 Ave. de Diego 435
Arecibo, PR 00612

Mailing address

PO Box 323
Quebradillas, PR 00678-0323
Phone (787) 817-4962

Other identifiers

IdentifierTypeStateIssuer
50128OtherPRPREFERED MEDICARE CHOICE
890390OtherPRMEDICARE Y MUCHO MAS

Other providers in Arecibo, PR

All providers in Arecibo, PR · Registered Dietitian in Puerto Rico

Sources for this page

Verify at the official NPI Registry.