Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 17664 | PR |
NPI | 1043441132 |
---|---|
Provider Name | Dr. Jancy Ninnette Acosta |
First Address | Juana Diaz, PR 00795-0520 |
Second Address | Juana Diaz, PR 00795 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 09/04/2010 |