Provider Demographics
NPI:1700077112
Name:ACHA, ADALID (MD)
Entity Type:Individual
Prefix:DR
First Name:ADALID
Middle Name:
Last Name:ACHA
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 1:886 GOOSE LAKE CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2464
Mailing Address - Country:US
Mailing Address - Phone:408-997-2699
Mailing Address - Fax:
Practice Address - Street 1:886 GOOSE LAKE CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-2464
Practice Address - Country:US
Practice Address - Phone:408-997-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALA31088146N00000X
CAA31088174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic