MEDICARE: DR. JENNIFER ACOSTAMADIEDO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0012X	Sleep Medicine (Internal Medicine) Physician	A170693	CA
2	207R00000X	Internal Medicine Physician	125071547	IL
3	207RP1001X	Pulmonary Disease Physician	A170693	CA

General Provider Information

NPI Number	:	1417479288
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER ACOSTAMADIEDO MD

Provider Business Mailing Address
First Line	:	1665 DOMINICAN WAY STE 222
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1515
Country	:	US
Telephone Number	:	844-387-5337
Fax Number	:	866-264-3890

Provider Business Practice Location Address
First Line	:	1665 DOMINICAN WAY STE 222
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95065-1515
Country	:	US
Telephone Number	:	844-387-5337
Fax Number	:	866-264-3890

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2017
Last Update Date	:	10/09/2024

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