Provider Demographics
NPI:1619925690
Name:ACOSTA, ALEXIS (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
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:PO BOX 1381
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-1381
Mailing Address - Country:US
Mailing Address - Phone:787-849-0099
Mailing Address - Fax:787-849-0912
Practice Address - Street 1:14 CALLE SAN ANTONIO
Practice Address - Street 2:HORMIGUEROS PLAZA SUITE 4
Practice Address - City:HORMIGUEROS
Practice Address - State:PR
Practice Address - Zip Code:00660-1708
Practice Address - Country:US
Practice Address - Phone:787-849-0099
Practice Address - Fax:787-849-0912
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16405208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice