Provider Demographics
NPI:1437152964
Name:ACOSTA CADENA, SURILO I (MD)
Entity Type:Individual
Prefix:DR
First Name:SURILO
Middle Name:I
Last Name:ACOSTA CADENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51526
Mailing Address - Street 2:
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00950-1526
Mailing Address - Country:US
Mailing Address - Phone:787-785-2694
Mailing Address - Fax:787-787-3109
Practice Address - Street 1:ZA1 CALLE 36
Practice Address - Street 2:URB. RIVERVIEW
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-3929
Practice Address - Country:US
Practice Address - Phone:787-785-2694
Practice Address - Fax:787-787-3109
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6413208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR068311OtherCRUZ AZUL PROVIDER
PR500403EOtherMMM PROVIDER
PR27740ACOtherSSS PROVIDER
PR2890OtherIMC PROVIDER
PR9500033OtherHUMANA PROVIDER
PR27740ACOtherSSS PROVIDER
PR2890OtherIMC PROVIDER