Provider Demographics
NPI:1952513517
Name:ACOSTA, ANGELICA NOEMI (PA)
Entity Type:Individual
Prefix:MS
First Name:ANGELICA
Middle Name:NOEMI
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:ANGELICA
Other - Middle Name:
Other - Last Name:CISNEROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:915 N MILPAS ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2331
Mailing Address - Country:US
Mailing Address - Phone:805-617-7858
Mailing Address - Fax:805-968-7041
Practice Address - Street 1:915 N MILPAS ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2331
Practice Address - Country:US
Practice Address - Phone:805-617-7858
Practice Address - Fax:805-968-7041
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16245363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant