Provider Demographics
NPI:1851316830
Name:ACOSTA, EMMANUEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:EMMANUEL
Middle Name:G
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2770 S MARYLAND PKWY STE 215
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89109-1565
Mailing Address - Country:US
Mailing Address - Phone:702-248-6850
Mailing Address - Fax:702-685-7242
Practice Address - Street 1:2770 S MARYLAND PKWY STE 215
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89109-1565
Practice Address - Country:US
Practice Address - Phone:702-248-6850
Practice Address - Fax:702-685-7242
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV10462208100000X
FLME 67043208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV10462OtherSTATE OF NEVADA MEDICAL LICENSE
FLME67043OtherSTATE OF FLORIDA MEDICAL