Basic Information
| Provider Information | |||||||||
| NPI: | 1497268155 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ACEVEDO | ||||||||
| FirstName: | JEMIFFER | ||||||||
| MiddleName: | PLAZA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2804 E. 26TH ST. | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | SIOUX FALLS | ||||||||
| State: | SD | ||||||||
| PostalCode: | 571034019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052712690 | ||||||||
| FaxNumber: | 6052712690 | ||||||||
| Practice Location | |||||||||
| Address1: | 6200 VIRGINIA PKWY | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750715504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2146506708 | ||||||||
| FaxNumber: | 6052713956 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2017 | ||||||||
| LastUpdateDate: | 12/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | N | 106S00000X | RBT-20-142954 | TX | Y |
No ID Information.