Provider Demographics
NPI:1609136357
Name:WAIKA ACOSTA NAZARIO-MEDICINA GENERAL, C.S.P.
Entity Type:Organization
Organization Name:WAIKA ACOSTA NAZARIO-MEDICINA GENERAL, C.S.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAIKA
Authorized Official - Middle Name:YAJAIRA
Authorized Official - Last Name:ACOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-375-9160
Mailing Address - Street 1:PO BOX 1492
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1492
Mailing Address - Country:US
Mailing Address - Phone:787-375-9160
Mailing Address - Fax:
Practice Address - Street 1:#18 CARRO STREET
Practice Address - Street 2:SUIT 101, ESTRELLA CORNER
Practice Address - City:SAN GERMAN
Practice Address - State:PR
Practice Address - Zip Code:00683
Practice Address - Country:US
Practice Address - Phone:787-375-9160
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15036208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty