Basic Information
| Provider Information | |||||||||
| NPI: | 1336164920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACEVES | ||||||||
| FirstName: | JAVIER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 SAN PABLO ST SE STE A | ||||||||
| Address2: | MSC10 5590 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871083167 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052722345 | ||||||||
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| Practice Location | |||||||||
| Address1: | YOUNG CHILDREN'S HEALTH CENTER | ||||||||
| Address2: | 306-A SAN PABLO SE | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 87108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052722345 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 90-140 | NM | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.