Provider Demographics
NPI:1508011610
Name:ACOSTA, RAFAEL A (DC)
Entity Type:Individual
Prefix:DR
First Name:RAFAEL
Middle Name:A
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 CALLE ANTONIO LUCIANO
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00924-3529
Mailing Address - Country:US
Mailing Address - Phone:787-701-3222
Mailing Address - Fax:
Practice Address - Street 1:1135 AVE 65 INFANTERIA
Practice Address - Street 2:SUITE 215-A
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00924-3402
Practice Address - Country:US
Practice Address - Phone:787-701-3222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR000454111N00000X
FLCH 9824111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0516954Medicaid
OH0516954Medicaid