Provider Demographics
NPI:1083688154
Name:ACOSTA GARCIA, LUIS A (MD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:ACOSTA GARCIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:ENSENADA
Mailing Address - State:PR
Mailing Address - Zip Code:00647
Mailing Address - Country:US
Mailing Address - Phone:787-848-8102
Mailing Address - Fax:787-848-8102
Practice Address - Street 1:8129 CONCORDIA ST
Practice Address - Street 2:STE 4A, CONCORDIA BLDG
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00731-8129
Practice Address - Country:US
Practice Address - Phone:787-848-8102
Practice Address - Fax:787-848-8102
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13798207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
100213OtherCRUZ AZUL
1284OtherAMERICAN HEALTH
7310403OtherHUMANA HMO
7310403OtherHUMANA GOLD PLUS
1605046OtherACAA
7310403OtherHUMANA GOLD CHOICE
E0423OtherCPO
7310403OtherHUMANA PPO
7839OtherIMC
7310403OtherHUMANA GOLD CHOICE
1605046OtherACAA