Provider Demographics
NPI:1780963405
Name:ACOSTA, BIANCA (PA)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N WILLIAMS RD
Mailing Address - Street 2:
Mailing Address - City:SAN BENITO
Mailing Address - State:TX
Mailing Address - Zip Code:78586-4118
Mailing Address - Country:US
Mailing Address - Phone:956-361-5009
Mailing Address - Fax:956-361-4539
Practice Address - Street 1:320 N WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586
Practice Address - Country:US
Practice Address - Phone:956-361-5009
Practice Address - Fax:956-361-4539
Is Sole Proprietor?:No
Enumeration Date:2011-08-11
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07265363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1780963405Medicaid