Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist |
NPI | 1144304544 |
---|---|
Provider Name | Daniel T. Acosta |
First Address | San Diego, CA 92101-5381 |
Second Address | San Diego, CA 92101-5381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2006 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DXX00002F | (05) | CA |
ZZZ02268Z | BLUE SHIELD (01) | CA |