Provider Demographics
NPI:1023399698
Name:ACOSTA, ANTONIETA SILVIA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANTONIETA
Middle Name:SILVIA
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:362 N CLOVIS AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0300
Mailing Address - Country:US
Mailing Address - Phone:559-327-2817
Mailing Address - Fax:877-301-1920
Practice Address - Street 1:362 N CLOVIS AVE STE 102
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0524
Practice Address - Country:US
Practice Address - Phone:559-327-2873
Practice Address - Fax:877-301-1920
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21740363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant