Provider Demographics
NPI:1184669293
Name:ACOSTA, ELVIRA B (MD)
Entity Type:Individual
Prefix:DR
First Name:ELVIRA
Middle Name:B
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:12 CROSS RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-7842
Mailing Address - Country:US
Mailing Address - Phone:702-339-8879
Mailing Address - Fax:702-360-0180
Practice Address - Street 1:12 CROSS RIDGE ST STE 160
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-7842
Practice Address - Country:US
Practice Address - Phone:702-233-2500
Practice Address - Fax:702-233-2525
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2024-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV7576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVA80508Medicare UPIN