Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD204458 | OR |
NPI | 1003306705 |
---|---|
Provider Name | Karla Carolina Acosta |
First Address | Portland, OR 97201-5048 |
Second Address | Hillsboro, OR 97124-6448 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2018 |
Last Update Date | 10/02/2022 |