Healthcare Provider Details

I. General information

NPI: 1396255121
Provider Name (Legal Business Name): YENDRY CHARLOTTE ACOSTA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2017
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

292 EUCLID AVE STE 115
SAN DIEGO CA
92114-3629
US

IV. Provider business mailing address

4440 TWAIN AVE APT 466
SAN DIEGO CA
92120-3495
US

V. Phone/Fax

Practice location:
  • Phone: 619-266-3332
  • Fax:
Mailing address:
  • Phone: 786-877-8577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number9331744
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9331744
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: