Provider Demographics
NPI:1619927571
Name:ACOSTA, REINALDO (MD)
Entity Type:Individual
Prefix:MR
First Name:REINALDO
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 1:315 N SAN SABA STE 1135
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3255
Mailing Address - Country:US
Mailing Address - Phone:210-704-3200
Mailing Address - Fax:
Practice Address - Street 1:315 N SAN SABA STE 930
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3154
Practice Address - Country:US
Practice Address - Phone:210-704-3200
Practice Address - Fax:210-704-2718
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT1889207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB32999OtherMEDICARE GROUP
WA8441172Medicaid
IL036125855Medicaid
WAG8857680OtherMEDICARE PTAN
WAG8857680OtherMEDICARE PTAN
WAGAB32999Medicare UPIN
WAGAB32999OtherMEDICARE GROUP