Provider Demographics
NPI:1326223827
Name:ACOSTA, LUIS F
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:F
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 1:8660 18TH ST
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-4504
Mailing Address - Country:US
Mailing Address - Phone:909-948-9907
Mailing Address - Fax:909-586-3501
Practice Address - Street 1:8660 18TH ST
Practice Address - Street 2:
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-4504
Practice Address - Country:US
Practice Address - Phone:909-948-9907
Practice Address - Fax:909-586-3501
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health