Healthcare Provider Details

I. General information

NPI: 1952853699
Provider Name (Legal Business Name): MRS. AMBER ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2016
Last Update Date: 10/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8913 E BELL RD STE 101B
SCOTTSDALE AZ
85260-1598
US

IV. Provider business mailing address

8913 E. BELL RD ST SUITE 101B
SCOTTSDALE AZ
85260
US

V. Phone/Fax

Practice location:
  • Phone: 480-860-2173
  • Fax:
Mailing address:
  • Phone: 480-860-2173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: