Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 35220 | AZ |
N | 2086S0120X | Pediatric Surgery | A66595 | CA |
N | 208D00000X | General Practice Physician | A66595 | CA |
NPI | 1467423772 |
---|---|
Provider Name | Dr. Juan M. Acosta |
First Address | Coachella, CA 92236-1534 |
Second Address | Coachella, CA 92236 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2006 |
Last Update Date | 21/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
078584 | (05) | AZ |
H68208 | (02) | AZ |