Provider Demographics
NPI:1720056500
Name:CORREA ACOSTA, CARLOS A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS A
Middle Name:
Last Name:CORREA 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 1:88 CALLE ROBLE
Mailing Address - Street 2:CIUDAD JARDIN III
Mailing Address - City:TOA ALTA
Mailing Address - State:PR
Mailing Address - Zip Code:00953-4859
Mailing Address - Country:US
Mailing Address - Phone:787-269-2641
Mailing Address - Fax:787-288-4578
Practice Address - Street 1:B6 AVE SANTA JUANITA
Practice Address - Street 2:SUNNY HILLS
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00956-5026
Practice Address - Country:US
Practice Address - Phone:787-269-2641
Practice Address - Fax:787-288-4578
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10175174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist