Provider Demographics
NPI:1952361750
Name:ACOSTA, LUIS S (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:S
Last Name: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 1:17203 RED OAK DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090
Mailing Address - Country:US
Mailing Address - Phone:281-444-2771
Mailing Address - Fax:281-444-6311
Practice Address - Street 1:17203 RED OAK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090
Practice Address - Country:US
Practice Address - Phone:281-444-2771
Practice Address - Fax:281-444-6311
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6703207RE0101X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0330409Medicaid
B20790Medicare UPIN
00ER81Medicare ID - Type Unspecified