Provider Demographics
NPI:1952488744
Name:PADILLA-ACOSTA, ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:PADILLA-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 1207
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1207
Mailing Address - Country:US
Mailing Address - Phone:787-265-6766
Mailing Address - Fax:787-831-9126
Practice Address - Street 1:21 CALLE DE DIEGO W
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4734
Practice Address - Country:US
Practice Address - Phone:787-265-6766
Practice Address - Fax:787-831-9126
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR006872207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine