Provider Demographics
NPI:1336465368
Name:CARLOS R ACOSTA JIMENEZ PSC
Entity Type:Organization
Organization Name:CARLOS R ACOSTA JIMENEZ PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-758-0023
Mailing Address - Street 1:PO BOX 363513
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-3513
Mailing Address - Country:US
Mailing Address - Phone:787-758-2300
Mailing Address - Fax:
Practice Address - Street 1:320 CALLE ELEONOR ROOSEVELT
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-2718
Practice Address - Country:US
Practice Address - Phone:787-758-0023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-15
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center