Provider Demographics
NPI:1245382563
Name:S ACOSTA, GUADALUPE (MD)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:
Last Name:S ACOSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GUADALUPE
Other - Middle Name:
Other - Last Name:SAMPER ACOSTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6801 SHELDON ROAD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-2754
Mailing Address - Country:US
Mailing Address - Phone:813-885-1770
Mailing Address - Fax:813-353-0861
Practice Address - Street 1:6801 SHELDON ROAD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-2754
Practice Address - Country:US
Practice Address - Phone:813-885-1770
Practice Address - Fax:813-353-0861
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94944208000000X
MDD0021622208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277756800Medicaid