Provider Demographics
NPI:1144384462
Name:ACOSTA, NEILA M (2234)
Entity Type:Individual
Prefix:DR
First Name:NEILA
Middle Name:M
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:2234
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB CIUDAD JARDIN
Mailing Address - Street 2:CALLE GLADIOLA #11
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987
Mailing Address - Country:US
Mailing Address - Phone:787-318-4944
Mailing Address - Fax:
Practice Address - Street 1:CAROLINA SHOPPING COURT
Practice Address - Street 2:OFIC 001
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00985
Practice Address - Country:US
Practice Address - Phone:787-257-0470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2234122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist