Provider Demographics
NPI:1134811268
Name:ACOSTA, MIGUEL A
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:A
Last Name:ACOSTA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MIGUEL
Other - Middle Name:A
Other - Last Name:ACOSTA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PRIVATE VEHICULE
Mailing Address - Street 1:HC 3 BOX 30414
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9198
Mailing Address - Country:US
Mailing Address - Phone:787-215-2848
Mailing Address - Fax:
Practice Address - Street 1:URB JARDINES DE GUERRERO
Practice Address - Street 2:CASA J12
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603
Practice Address - Country:US
Practice Address - Phone:787-215-2848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-25
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2293274347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle