Provider Demographics
NPI:1629538665
Name:ACOSTA, STEFANIE SALAVERIA (MD)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:SALAVERIA
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:SALAVERIA
Other - Last Name:CONCEPCION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:204 COUNTRY HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-7107
Mailing Address - Country:US
Mailing Address - Phone:337-298-2113
Mailing Address - Fax:
Practice Address - Street 1:121 RUE LOUIS XIV STE 6
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-5786
Practice Address - Country:US
Practice Address - Phone:337-269-7494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA333407207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine