Provider Demographics
NPI:1528030236
Name:ACOSTA, HUMBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:HUMBERTO
Middle Name:
Last Name:ACOSTA
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 1:195 CALLE PICAFLOR
Mailing Address - Street 2:QUINTAS DE CABO ROJO
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-4229
Mailing Address - Country:US
Mailing Address - Phone:787-851-1400
Mailing Address - Fax:787-255-4125
Practice Address - Street 1:5 CALLE MACEO
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3509
Practice Address - Country:US
Practice Address - Phone:787-851-1400
Practice Address - Fax:787-255-4125
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-06
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0087780Medicare PIN
PRG41540Medicare UPIN