Healthcare Provider Details

I. General information

NPI: 1669001376
Provider Name (Legal Business Name): JONATHAN ACOSTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8805 HAVEN AVE STE 110&200
RANCHO CUCAMONGA CA
91730-5149
US

IV. Provider business mailing address

913 E 26TH ST STE 600
MINNEAPOLIS MN
55404-4515
US

V. Phone/Fax

Practice location:
  • Phone: 909-912-1750
  • Fax:
Mailing address:
  • Phone: 612-775-6257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberA206331
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number78665
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: