Healthcare Provider Details

I. General information

NPI: 1134001142
Provider Name (Legal Business Name): ALEJANDRO EMILIO ACOSTA MENDOZA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 LINVILLE RIDGE CT APT 11
WINSTON SALEM NC
27101-6249
US

IV. Provider business mailing address

309 LINVILLE RIDGE CT APT 11
WINSTON SALEM NC
27101-6249
US

V. Phone/Fax

Practice location:
  • Phone: 336-926-4475
  • Fax:
Mailing address:
  • Phone: 704-780-4271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: