MEDICARE: DR. ALEXIS ACOSTA M.D.

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	208D00000X	General Practice Physician	16405	PR

General Provider Information

NPI Number	:	1619925690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS ACOSTA M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1381
Second Line	:
City	:	CABO ROJO
State	:	PR
Zip	:	00623-1381
Country	:	US
Telephone Number	:	787-849-0099
Fax Number	:	787-849-0912

Provider Business Practice Location Address
First Line	:	14 CALLE SAN ANTONIO
Second Line	:	HORMIGUEROS PLAZA SUITE 4
City	:	HORMIGUEROS
State	:	PR
Zip	:	00660-1708
Country	:	US
Telephone Number	:	787-849-0099
Fax Number	:	787-849-0912

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/08/2007

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