Provider Demographics
NPI:1972663466
Name:ACOSTA, ROSALVA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ROSALVA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ROSALVA
Other - Middle Name:
Other - Last Name:ZUNIGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1425 N HUNT CLUB RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2632
Mailing Address - Country:US
Mailing Address - Phone:847-548-2200
Mailing Address - Fax:847-548-2865
Practice Address - Street 1:1425 N HUNT CLUB RD STE 100
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2632
Practice Address - Country:US
Practice Address - Phone:847-548-2200
Practice Address - Fax:847-548-2865
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085-001716363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP80485Medicare UPIN