Provider Demographics
NPI:1922532738
Name:ACOSTA GONZALEZ, LUIS RAMON (SA-C)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:RAMON
Last Name:ACOSTA GONZALEZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 HOMEWARD LN
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2701
Mailing Address - Country:US
Mailing Address - Phone:407-437-9597
Mailing Address - Fax:
Practice Address - Street 1:1155 HOMEWARD LN
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2701
Practice Address - Country:US
Practice Address - Phone:407-437-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-226246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant