Provider Demographics
NPI:1184219412
Name:ACOSTA, LUIS GERARDO
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:GERARDO
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 CRESCENT CT APT 1
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-4748
Mailing Address - Country:US
Mailing Address - Phone:956-312-9413
Mailing Address - Fax:
Practice Address - Street 1:1404 CRESCENT CT APT 1
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78541-4748
Practice Address - Country:US
Practice Address - Phone:956-312-9413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer