Healthcare Provider Details

I. General information

NPI: 1861418618
Provider Name (Legal Business Name): JOSE ALFREDO ACOSTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34800 BOB WILSON DR NAVAL MEDICAL CENTER SAN DIEGO DEPARTMENT OF SURGERY
SAN DIEGO CA
92134-1098
US

IV. Provider business mailing address

4249 WITHERBY ST
SAN DIEGO CA
92103-1132
US

V. Phone/Fax

Practice location:
  • Phone: 619-532-7579
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number009318
License Number StatePR
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberG78966
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number87-375
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberMD30309
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: