Provider Demographics
NPI:1518959154
Name:ACOSTA, KYLE VALENTINO (MD)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:VALENTINO
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 GREENBRIAR BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-7235
Mailing Address - Country:US
Mailing Address - Phone:985-898-2001
Mailing Address - Fax:985-898-2909
Practice Address - Street 1:200 GREENBRIAR BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-7235
Practice Address - Country:US
Practice Address - Phone:985-898-2001
Practice Address - Fax:985-898-2909
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA020533207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1661431Medicaid
LA5CA67Medicare PIN
G05016Medicare UPIN
LA5W180Medicare PIN