Provider Demographics
NPI:1477833754
Name:LUIS D. ACOSTA M.D.P.A.
Entity Type:Organization
Organization Name:LUIS D. ACOSTA M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.P.A.
Authorized Official - Prefix:DR
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-541-1166
Mailing Address - Street 1:1201 N MESA ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-4517
Mailing Address - Country:US
Mailing Address - Phone:915-541-1166
Mailing Address - Fax:915-541-1175
Practice Address - Street 1:1201 N MESA ST
Practice Address - Street 2:SUITE E
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4517
Practice Address - Country:US
Practice Address - Phone:915-541-1166
Practice Address - Fax:915-541-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ37132084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115276101Medicaid
TX115276101Medicaid