Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A4224 | CA |
NPI | 1003853649 |
---|---|
Provider Name | Dr. Robert Marroquin Acosta |
First Address | Tracy, CA 95376-3080 |
Second Address | Tracy, CA 95376-3080 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E08746 | (02) | CA |