Healthcare Provider Details

I. General information

NPI: 1659885879
Provider Name (Legal Business Name): MISS CHANTAL ACOSTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2017
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 17TH ST
BAKERSFIELD CA
93301-4504
US

IV. Provider business mailing address

3812 WAGON WAY
SHAFTER CA
93263-2357
US

V. Phone/Fax

Practice location:
  • Phone: 661-636-4025
  • Fax:
Mailing address:
  • Phone: 661-229-9940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number142713
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: