Provider Demographics
NPI:1225266794
Name:ACOSTA, LUISA (SP)
Entity Type:Individual
Prefix:
First Name:LUISA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:SP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17291 IRVINE BLVD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-2941
Mailing Address - Country:US
Mailing Address - Phone:714-730-7700
Mailing Address - Fax:714-730-7766
Practice Address - Street 1:17291 IRVINE BLVD
Practice Address - Street 2:SUITE 325
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-2941
Practice Address - Country:US
Practice Address - Phone:714-730-7700
Practice Address - Fax:714-730-7766
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP 10738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist