Provider Demographics
NPI:1396389862
Name:ACOSTA MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:ACOSTA MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-914-6875
Mailing Address - Street 1:PO BOX 2110
Mailing Address - Street 2:
Mailing Address - City:YABUCOA
Mailing Address - State:PR
Mailing Address - Zip Code:00767-2110
Mailing Address - Country:US
Mailing Address - Phone:787-266-0242
Mailing Address - Fax:787-893-5548
Practice Address - Street 1:SUITE 1 CALLE MARGINAL
Practice Address - Street 2:URB MENDEZ #6
Practice Address - City:YABUCOA
Practice Address - State:PR
Practice Address - Zip Code:00767
Practice Address - Country:US
Practice Address - Phone:787-266-0242
Practice Address - Fax:787-893-5548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty