Provider Demographics
NPI:1154330041
Name:ACOSTA, GLORIA ACEVEDO (MD)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ACEVEDO
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4409
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00605-4409
Mailing Address - Country:US
Mailing Address - Phone:787-891-0513
Mailing Address - Fax:787-891-0513
Practice Address - Street 1:REPARTO RUBIANES 47 AVENUE SEVERIANO CUEVAS
Practice Address - Street 2:SUITE NUMBER 2
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-891-0513
Practice Address - Fax:787-891-0513
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR9808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist