Provider Demographics
NPI:1528602448
Name:ACOSTA GUTIERREZ, MARIA ISABEL (MA/GI TECH)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:ISABEL
Last Name:ACOSTA GUTIERREZ
Suffix:
Gender:F
Credentials:MA/GI TECH
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ISABEL
Other - Last Name:ACOSTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA/GITECH
Mailing Address - Street 1:3186 AIRWAY AVE # ATEA
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4650
Mailing Address - Country:US
Mailing Address - Phone:714-981-0427
Mailing Address - Fax:714-327-0673
Practice Address - Street 1:3186 AIRWAY AVE # ATEA
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4650
Practice Address - Country:US
Practice Address - Phone:714-981-0427
Practice Address - Fax:714-327-0673
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst